Healthcare Provider Details

I. General information

NPI: 1205906260
Provider Name (Legal Business Name): DISCOUNT DRUG MART, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MAIN STREET
SANDY HOOK KY
41171-0187
US

IV. Provider business mailing address

108 MAIN STREET P.O. BOX 187
SANDY HOOK KY
41171-0187
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-5111
  • Fax: 606-738-4018
Mailing address:
  • Phone: 606-738-5111
  • Fax: 606-738-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO2011
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO2011
License Number StateKY

VIII. Authorized Official

Name: MS. DEBORAH LEE BREWER
Title or Position: PRESIDENT
Credential: RPH
Phone: 606-738-5111