Healthcare Provider Details

I. General information

NPI: 1730210956
Provider Name (Legal Business Name): CAVE RUN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 OLD FLEMINGSBURG RD
MOREHEAD KY
40351-1090
US

IV. Provider business mailing address

255 OLD FLEMINGSBURG RD
MOREHEAD KY
40351-1090
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-1511
  • Fax: 606-783-0075
Mailing address:
  • Phone: 606-783-1511
  • Fax: 606-783-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPO1266
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number1266
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1266
License Number StateKY

VIII. Authorized Official

Name: DR. CHEYENNE BABER
Title or Position: PRESIDENT
Credential:
Phone: 606-783-1511