Healthcare Provider Details

I. General information

NPI: 1245320290
Provider Name (Legal Business Name): MARROWBONE CLINIC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10363 REGINA BELCHER HWY
REGINA KY
41559
US

IV. Provider business mailing address

PO BOX 225
REGINA KY
41559-0225
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-7085
  • Fax: 606-754-9218
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPO1360
License Number StateKY

VIII. Authorized Official

Name: JAMES HUFFMAN
Title or Position: MANAGER
Credential: RPH
Phone: 606-754-7085