Healthcare Provider Details

I. General information

NPI: 1386646974
Provider Name (Legal Business Name): INSTITUTIONAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E 6TH ST
CORBIN KY
40701-1422
US

IV. Provider business mailing address

PO BOX 1450
CORBIN KY
40702-1450
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-9600
  • Fax: 606-528-3853
Mailing address:
  • Phone: 606-528-9600
  • Fax: 606-528-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberP06791
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP06791
License Number StateKY

VIII. Authorized Official

Name: MR. TERRY FORCHT
Title or Position: OWNER
Credential:
Phone: 606-528-9600