Healthcare Provider Details

I. General information

NPI: 1962091322
Provider Name (Legal Business Name): JOHN LUKE WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 N MAIN ST
JAMESTOWN KY
42629-2411
US

IV. Provider business mailing address

PO BOX 499
JAMESTOWN KY
42629-0499
US

V. Phone/Fax

Practice location:
  • Phone: 270-343-4443
  • Fax: 270-343-4481
Mailing address:
  • Phone: 270-343-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020933
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: