Healthcare Provider Details

I. General information

NPI: 1346375359
Provider Name (Legal Business Name): BERINGER DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WEST MAIN ST SUITE A
WARSAW KY
41095
US

IV. Provider business mailing address

PO BOX 608
CRESCENT CITY FL
32112-0608
US

V. Phone/Fax

Practice location:
  • Phone: 859-567-4678
  • Fax: 859-567-4674
Mailing address:
  • Phone: 859-567-4678
  • Fax: 859-567-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP06107
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO6107
License Number StateKY

VIII. Authorized Official

Name: PATTY LONG
Title or Position: VP
Credential:
Phone: 386-698-3737