Healthcare Provider Details

I. General information

NPI: 1255354239
Provider Name (Legal Business Name): KENTUCKY HC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 UPPER JOHNS CREEK RD
KIMPER KY
41539
US

IV. Provider business mailing address

PO BOX 763
GRUNDY VA
24614-0763
US

V. Phone/Fax

Practice location:
  • Phone: 606-631-3327
  • Fax: 606-631-3320
Mailing address:
  • Phone: 276-935-4777
  • Fax: 276-935-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07103
License Number StateKY

VIII. Authorized Official

Name: JOEL THORNBURY
Title or Position: MEMBER
Credential: RPH
Phone: 606-432-2274