Healthcare Provider Details

I. General information

NPI: 1205849841
Provider Name (Legal Business Name): SUTTON PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W MAPLE AVE
LANCASTER KY
40444-1058
US

IV. Provider business mailing address

330 W MAPLE AVE
LANCASTER KY
40444-1058
US

V. Phone/Fax

Practice location:
  • Phone: 859-792-4611
  • Fax: 859-792-3511
Mailing address:
  • Phone: 859-792-4611
  • Fax: 859-792-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO7829
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO7829
License Number StateKY

VIII. Authorized Official

Name: SCOTT GRAHAM
Title or Position: OWNER
Credential: RPH
Phone: 859-792-4611