Healthcare Provider Details

I. General information

NPI: 1528237575
Provider Name (Legal Business Name): PASADENA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PASADENA DR
LEXINGTON KY
40503-2925
US

IV. Provider business mailing address

280 PASADENA DR
LEXINGTON KY
40503-2925
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-2469
  • Fax:
Mailing address:
  • Phone: 859-260-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07228
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberP07228
License Number StateKY

VIII. Authorized Official

Name: MR. GARY S HARRIS
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 859-260-2469