Healthcare Provider Details

I. General information

NPI: 1134270119
Provider Name (Legal Business Name): WHITESVILLE D S INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 ARGILLITE RD
FLATWOODS KY
41139-1692
US

IV. Provider business mailing address

PO BOX 701
FLATWOODS KY
41139-0701
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-4313
  • Fax: 606-617-6464
Mailing address:
  • Phone: 606-836-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07057
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY GOETZ
Title or Position: OWNER
Credential: RPH
Phone: 606-836-4313