Healthcare Provider Details

I. General information

NPI: 1992747455
Provider Name (Legal Business Name): CRESTVILLE DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 N BEND RD STE C
HEBRON KY
41048-9123
US

IV. Provider business mailing address

1980 N BEND RD STE C
HEBRON KY
41048-9123
US

V. Phone/Fax

Practice location:
  • Phone: 859-689-9084
  • Fax: 859-689-9444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPO7056
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENISE SCHICKLING
Title or Position: PRESIDENT
Credential: RPH
Phone: 859-341-1666