Healthcare Provider Details

I. General information

NPI: 1528648375
Provider Name (Legal Business Name): FAMILY CLINIC MANCHASTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 RICHMOND RD UNIT B
MANCHESTER KY
40962-1212
US

IV. Provider business mailing address

415 RICHMOND RD UNIT B
MANCHESTER KY
40962-1212
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-8831
  • Fax:
Mailing address:
  • Phone: 606-598-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER SAAD
Title or Position: PRESIDENT
Credential:
Phone: 318-259-7334