Healthcare Provider Details

I. General information

NPI: 1528517034
Provider Name (Legal Business Name): MED-SAVE 4 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 STANFORD ST
LANCASTER KY
40444
US

IV. Provider business mailing address

208 STANFORD ST
LANCASTER KY
40444-1237
US

V. Phone/Fax

Practice location:
  • Phone: 859-792-1697
  • Fax: 859-792-2343
Mailing address:
  • Phone: 859-792-1697
  • Fax: 859-792-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07799
License Number StateKY

VIII. Authorized Official

Name: SHERRY STEVENS
Title or Position: OFFICE MANAGER
Credential:
Phone: 859-792-1697