Healthcare Provider Details

I. General information

NPI: 1982058517
Provider Name (Legal Business Name): PDC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/16/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W MAIN ST
PRINCETON KY
42445-1546
US

IV. Provider business mailing address

103 W MAIN ST
PRINCETON KY
42445-1546
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-5585
  • Fax:
Mailing address:
  • Phone: 270-365-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07858
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JIMMY L TUCKER
Title or Position: OWNER, PRESIDENT, CEO
Credential: RPH
Phone: 270-365-5585