Healthcare Provider Details

I. General information

NPI: 1891502647
Provider Name (Legal Business Name): FIDDLEWOOD FARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 HIGHWAY 54 LOWR LEVEL1
PHILPOT KY
42366-9642
US

IV. Provider business mailing address

6071 HIGHWAY 54 LOWR LEVEL1
PHILPOT KY
42366-9642
US

V. Phone/Fax

Practice location:
  • Phone: 270-713-3276
  • Fax: 270-246-9719
Mailing address:
  • Phone: 270-713-3276
  • Fax: 270-246-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOHN TYLER
Title or Position: OWNER
Credential: DC
Phone: 270-313-7920