Healthcare Provider Details

I. General information

NPI: 1013258649
Provider Name (Legal Business Name): WHITESBURG MEDICAL CENTER PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MEDICAL PLAZA LN
WHITESBURG KY
41858-7425
US

IV. Provider business mailing address

226 MEDICAL PLAZA LN
WHITESBURG KY
41858-7425
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4871
  • Fax: 606-633-4570
Mailing address:
  • Phone: 606-633-4871
  • Fax: 606-633-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07557
License Number StateKY

VIII. Authorized Official

Name: EARNEST J WATTS
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 606-633-2222