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General NPI Number Information
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NPI Number | 1104270040
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Entity Type | Organization
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Legal Business Name | KMART PHARMACY
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 2965 HEMINGWAY LANE
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City | LEXINGTON
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State | KY
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Zip | 40513-0000
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Country | US
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Telephone | 859-539-0485
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Fax |
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Provider Business Mailing Address
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Address Line | 2965 HEMINGWAY LN
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City | LEXINGTON
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State | KY
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Zip | 40513-1856
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. NATASHA PISTILLI
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Credential | PHARM.D.
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Telephone | 859-539-0485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 018196
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License Number State | KY
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