Healthcare Provider Details

I. General information

NPI: 1194862268
Provider Name (Legal Business Name): LEWISPORT DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 US HIGHWAY 60 W
LEWISPORT KY
42351-7214
US

IV. Provider business mailing address

8525 US HIGHWAY 60
LEWISPORT KY
42351
US

V. Phone/Fax

Practice location:
  • Phone: 270-295-3356
  • Fax: 270-295-3055
Mailing address:
  • Phone: 270-295-3356
  • Fax: 270-295-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberP01857
License Number StateKY

VIII. Authorized Official

Name: MR. JOEL S WHITE
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 270-295-3356