Healthcare Provider Details

I. General information

NPI: 1780138396
Provider Name (Legal Business Name): ONCOLOGY ASSOCIATES INC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 KENTUCKY AVE STE 403
PADUCAH KY
42003-3830
US

IV. Provider business mailing address

2603 KENTUCKY AVE STE 403
PADUCAH KY
42003-3830
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-3930
  • Fax: 270-442-1470
Mailing address:
  • Phone: 270-444-3930
  • Fax: 270-442-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07772
License Number StateKY

VIII. Authorized Official

Name: VAN BOWDEN
Title or Position: PIC
Credential: RPH
Phone: 270-444-3930