Healthcare Provider Details

I. General information

NPI: 1588375166
Provider Name (Legal Business Name): ANDREW RICHARD BARNES PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HIGHWAY 80
HYDEN KY
41749-8501
US

IV. Provider business mailing address

130 HIGHWAY 80
HYDEN KY
41749-8501
US

V. Phone/Fax

Practice location:
  • Phone: 606-672-3084
  • Fax:
Mailing address:
  • Phone: 606-672-3084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023200
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: