=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144213406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANHAUER DRUG CO, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2005
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 FREDERICA ST
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42301-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-684-2341
-----------------------------------------------------
Fax | 270-684-2396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 FREDERICA ST
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42301-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-684-2341
-----------------------------------------------------
Fax | 270-684-2396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY WILLIAM DANHAUER
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 270-684-2341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | P00684
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | P0684
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------