Healthcare Provider Details

I. General information

NPI: 1669508065
Provider Name (Legal Business Name): HUTCHINSON DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MAIN ST SUITE 130
LEXINGTON KY
40507-1640
US

IV. Provider business mailing address

401 W MAIN ST SUITE 130
LEXINGTON KY
40507-1640
US

V. Phone/Fax

Practice location:
  • Phone: 859-252-3554
  • Fax: 859-252-3555
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO0870
License Number StateKY

VIII. Authorized Official

Name: JOHN HUTCHINSON
Title or Position: OWNER
Credential: RPH
Phone: 859-252-3554