Healthcare Provider Details

I. General information

NPI: 1124089180
Provider Name (Legal Business Name): P I C CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SLATE AVE
OWINGSVILLE KY
40360-2201
US

IV. Provider business mailing address

PO BOX 1119 60 SLATE AVE.
OWINGSVILLE KY
40360-1119
US

V. Phone/Fax

Practice location:
  • Phone: 606-674-6979
  • Fax: 606-674-2637
Mailing address:
  • Phone: 606-674-6979
  • Fax: 606-674-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP01897
License Number StateKY

VIII. Authorized Official

Name: MELODIE HAWKINS
Title or Position: OWNER,PIC,AO
Credential: RPH
Phone: 606-674-6979