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General NPI Number Information
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NPI Number | 1164554192
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Entity Type | Organization
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Legal Business Name | STOVALLS PRESCRIPTION SHOP INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 31 BURNLEY RD
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City | SCOTTSVILLE
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State | KY
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Zip | 42164-6357
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Country | US
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Telephone | 270-618-4444
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Fax | 270-622-3996
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Provider Business Mailing Address
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Address Line | PO BOX 217
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City | SCOTTSVILLE
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State | KY
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Zip | 42164-0217
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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 | PHARMACIST AND OWNER
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Name | LARRY STOVALL
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Credential |
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Telephone | 270-237-5402
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P06384
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License Number State | KY
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