Healthcare Provider Details

I. General information

NPI: 1649355934
Provider Name (Legal Business Name): STURGIS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 N ADAMS ST
STURGIS KY
42459-1413
US

IV. Provider business mailing address

523 N ADAMS ST
STURGIS KY
42459-1413
US

V. Phone/Fax

Practice location:
  • Phone: 270-333-4672
  • Fax: 270-333-4478
Mailing address:
  • Phone: 270-333-4672
  • Fax: 270-333-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07521
License Number StateKY

VIII. Authorized Official

Name: JONATHAN RATLEY
Title or Position: PHARMACIST
Credential:
Phone: 270-333-4672