Healthcare Provider Details

I. General information

NPI: 1295110526
Provider Name (Legal Business Name): PAT'S PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 W MAIN ST
LEBANON KY
40033-1362
US

IV. Provider business mailing address

498 W MAIN ST
LEBANON KY
40033-1362
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-4950
  • Fax: 270-692-2320
Mailing address:
  • Phone: 270-692-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06177
License Number StateKY

VIII. Authorized Official

Name: JOSEPH KELLY JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 270-692-4950