Healthcare Provider Details

I. General information

NPI: 1467564310
Provider Name (Legal Business Name): KYVA INVESTMENTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E MAIN ST
WHITESBURG KY
41858-7351
US

IV. Provider business mailing address

109 E MAIN ST
WHITESBURG KY
41858-7351
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4488
  • Fax: 606-633-4849
Mailing address:
  • Phone: 606-633-4488
  • Fax: 606-633-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06331
License Number StateKY

VIII. Authorized Official

Name: BERNARDINE MIRACLE
Title or Position: PIC,AO
Credential: RPH
Phone: 606-633-4488