Healthcare Provider Details

I. General information

NPI: 1962500934
Provider Name (Legal Business Name): GRANT COUNTY DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/19/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S MAIN ST
DRY RIDGE KY
41035-7329
US

IV. Provider business mailing address

PO BOX 106
DRY RIDGE KY
41035-0106
US

V. Phone/Fax

Practice location:
  • Phone: 859-823-5271
  • Fax: 859-823-0039
Mailing address:
  • Phone: 859-823-5271
  • Fax: 859-823-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06853
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON WALLACE
Title or Position: OWNER
Credential: RPH
Phone: 859-823-5271