Healthcare Provider Details

I. General information

NPI: 1962488700
Provider Name (Legal Business Name): BERINGER DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W MAIN ST SUITE A
WARSAW KY
41095-9300
US

IV. Provider business mailing address

102 W MAIN ST SUITE A
WARSAW KY
41095-9300
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 Code333600000X
TaxonomyPharmacy
License NumberP06107
License Number StateKY

VIII. Authorized Official

Name: MRS. PATRICIA DOROTHY LONG
Title or Position: V.P.
Credential:
Phone: 386-698-3737