Healthcare Provider Details

I. General information

NPI: 1215416599
Provider Name (Legal Business Name): PRESTONSBURG PHARMACIST GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 UNIVERSITY DR STE 100
PRESTONSBURG KY
41653-1080
US

IV. Provider business mailing address

1002 S BROADWAY ST STE 7
GEORGETOWN KY
40324-1463
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-1202
  • Fax:
Mailing address:
  • Phone: 859-402-4853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN BELL
Title or Position: OWNER
Credential:
Phone: 859-402-4853