Healthcare Provider Details

I. General information

NPI: 1508111782
Provider Name (Legal Business Name): EAST KENTUCKY DRUG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CONN ST STE 2
IVEL KY
41642-9406
US

IV. Provider business mailing address

PO BOX 155
IVEL KY
41642-0155
US

V. Phone/Fax

Practice location:
  • Phone: 606-478-3784
  • Fax: 606-478-3788
Mailing address:
  • Phone: 606-478-3784
  • Fax: 606-478-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07512
License Number StateKY

VIII. Authorized Official

Name: ROBIN JUSTICE
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 606-478-3784