Healthcare Provider Details

I. General information

NPI: 1508469297
Provider Name (Legal Business Name): HERBERT WAYNE RICE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 CEDAR ST
KUTTAWA KY
42055-6287
US

IV. Provider business mailing address

PO BOX 459
KUTTAWA KY
42055-0459
US

V. Phone/Fax

Practice location:
  • Phone: 270-388-7371
  • Fax: 270-388-5675
Mailing address:
  • Phone: 270-388-7371
  • Fax: 270-388-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010652
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: