Healthcare Provider Details

I. General information

NPI: 1730294760
Provider Name (Legal Business Name): ELKHORN DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E ELKHORN ST
ELKHORN CITY KY
41522-8557
US

IV. Provider business mailing address

PO BOX 532
ELKHORN CITY KY
41522-0532
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-0221
  • Fax: 606-754-0225
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06897
License Number StateKY

VIII. Authorized Official

Name: ROBERT LESTER
Title or Position: OWNER
Credential: PHARM D
Phone: 606-754-0221