Healthcare Provider Details

I. General information

NPI: 1629132436
Provider Name (Legal Business Name): NEW LEXINGTON CLINIC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-4103
  • Fax: 859-258-4555
Mailing address:
  • Phone: 859-258-4103
  • Fax: 859-258-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP02259
License Number StateKY

VIII. Authorized Official

Name: LINDA HICKS
Title or Position: SR. DIRECTOR OF OPERATIONS
Credential: RPH
Phone: 859-258-4228