Healthcare Provider Details

I. General information

NPI: 1871618975
Provider Name (Legal Business Name): SUTTON DRUGS OF LA CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 BROADWAY
LACENTER KY
42056
US

IV. Provider business mailing address

PO BOX 179
LA CENTER KY
42056-0179
US

V. Phone/Fax

Practice location:
  • Phone: 270-665-5192
  • Fax: 270-665-9296
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP01069
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: WENDY RENEE RENFROW
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 270-665-5192