Healthcare Provider Details

I. General information

NPI: 1821175480
Provider Name (Legal Business Name): MARTIN COUNTY FAMILY DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MAIN STREET
INEZ KY
41224-0306
US

IV. Provider business mailing address

117 MAIN STREET PO BOX 306
INEZ KY
41224-0306
US

V. Phone/Fax

Practice location:
  • Phone: 606-298-7512
  • Fax: 606-298-7615
Mailing address:
  • Phone: 606-298-7512
  • Fax: 606-298-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP00205
License Number StateKY

VIII. Authorized Official

Name: MRS. ROSEMARY GOBLE
Title or Position: OWNER PRESIDENT
Credential: RPH
Phone: 606-298-7512