Healthcare Provider Details

I. General information

NPI: 1437172418
Provider Name (Legal Business Name): EDMONSON DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK PLACE, STE 8
BROWNSVILLE KY
42210-0058
US

IV. Provider business mailing address

PO BOX 58
BROWNSVILLE KY
42210-0058
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-2386
  • Fax: 844-682-8099
Mailing address:
  • Phone: 270-597-2386
  • Fax: 844-682-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07681
License Number StateKY

VIII. Authorized Official

Name: TREVOR RAY
Title or Position: OWNER/SECRETARY
Credential: PHARMD
Phone: 270-597-2386