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General NPI Number Information
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NPI Number | 1215391149
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Entity Type | Organization
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Legal Business Name | SEARS HOLDING COMPANY
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 420 E HIGHWAY 80
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City | SOMERSET
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State | KY
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Zip | 42501-1691
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Country | US
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Telephone | 606-679-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E HIGHWAY 80
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City | SOMERSET
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State | KY
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Zip | 42501-1691
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Country | US
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Telephone | 606-679-1121
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Fax |
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Authorized Official
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Title or Position | DISTRICT LEAD
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Name | MR. DUSTIN SALYER
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Credential | RPH
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Telephone | 859-312-9648
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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 | 183500000X
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License Number State | KY
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