Healthcare Provider Details

I. General information

NPI: 1134165152
Provider Name (Legal Business Name): BIG SANDY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 DOUGLAS PKWY SHELBY VALLEY CLINIC PHARMACY
PIKEVILLE KY
41501-6970
US

IV. Provider business mailing address

1709 KY ROUTE 321 SUITE 3 BIG SANDY HEALTH CARE INC
PRESTONSBURG KY
41653-9101
US

V. Phone/Fax

Practice location:
  • Phone: 606-639-3136
  • Fax: 606-653-1166
Mailing address:
  • Phone: 606-886-8546
  • Fax: 606-886-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberP06965
License Number StateKY

VIII. Authorized Official

Name: MR. JAMES HERALD
Title or Position: CEO
Credential:
Phone: 606-886-8546