Healthcare Provider Details

I. General information

NPI: 1588783625
Provider Name (Legal Business Name): ROCKCASTLE VENTURES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NEWCOMB AVENUE
MT. VERNON KY
40456
US

IV. Provider business mailing address

PO BOX 1860
MOUNT VERNON KY
40456-1860
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-4613
  • Fax:
Mailing address:
  • Phone: 606-256-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07179
License Number StateKY

VIII. Authorized Official

Name: BRANDY BULLOCK
Title or Position: DIRECTOR
Credential:
Phone: 606-256-7761