Healthcare Provider Details

I. General information

NPI: 1679527675
Provider Name (Legal Business Name): HARLAN MEDICAL CENTER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 VILLAGE CENTER RD
HARLAN KY
40831-1777
US

IV. Provider business mailing address

132 VILLAGE CENTER RD
HARLAN KY
40831-1777
US

V. Phone/Fax

Practice location:
  • Phone: 606-573-2004
  • Fax: 606-573-0007
Mailing address:
  • Phone: 606-573-2004
  • Fax: 606-573-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06925
License Number StateKY

VIII. Authorized Official

Name: BRIAN KEY
Title or Position: VP, PIC,AO
Credential: RPH
Phone: 606-573-2004