Healthcare Provider Details

I. General information

NPI: 1225069487
Provider Name (Legal Business Name): STULTZ PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 ASHLAND RD
GREENUP KY
41144-1207
US

IV. Provider business mailing address

1615 ASHLAND RD
GREENUP KY
41144-1207
US

V. Phone/Fax

Practice location:
  • Phone: 606-473-7346
  • Fax: 606-473-5667
Mailing address:
  • Phone: 606-473-7346
  • Fax: 606-473-5667

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 NumberP01316
License Number StateKY

VIII. Authorized Official

Name: BRAD STULTZ
Title or Position: OWNER
Credential:
Phone: 606-473-7346