Healthcare Provider Details

I. General information

NPI: 1912070525
Provider Name (Legal Business Name): NIES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11745 MADISON PIKE
INDEPENDENCE KY
41051-8637
US

IV. Provider business mailing address

11745 MADISON PIKE
INDEPENDENCE KY
41051-8637
US

V. Phone/Fax

Practice location:
  • Phone: 859-356-3941
  • Fax: 859-356-0338
Mailing address:
  • Phone: 859-356-3941
  • Fax: 859-356-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06272
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberP06272
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP06272
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN NIE
Title or Position: PRESIDENT
Credential: RPH.
Phone: 859-356-3941