Healthcare Provider Details

I. General information

NPI: 1750487260
Provider Name (Legal Business Name): WILMORE PHARMACIST GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MAIN ST
WILMORE KY
40390-1321
US

IV. Provider business mailing address

201 E MAIN ST
WILMORE KY
40390-1321
US

V. Phone/Fax

Practice location:
  • Phone: 859-858-2453
  • Fax: 859-858-2436
Mailing address:
  • Phone: 859-858-2453
  • Fax: 859-858-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberP06971
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberP06971
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06971
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN J MCDANIEL
Title or Position: PHARMACIST
Credential:
Phone: 859-858-2453