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General NPI Number Information
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NPI Number | 1063542082
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Entity Type | Organization
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Legal Business Name | BAPTIST HEALTHCARE AFFILIATES
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 1025 NEW MOODY LN
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City | LAGRANGE
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State | KY
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Zip | 40031-9154
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Country | US
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Telephone | 502-222-3362
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Fax | 502-222-8684
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Provider Business Mailing Address
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Address Line | 1025 NEW MOODY LN
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City | LAGRANGE
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State | KY
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Zip | 40031-9154
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Country | US
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Telephone | 502-222-3362
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Fax | 502-222-8684
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DENNIS JOHNSON
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Credential |
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Telephone | 502-222-3329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | P05196
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License Number State | KY
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