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General NPI Number Information
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NPI Number | 1225106057
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Entity Type | Organization
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Legal Business Name | BLUEGRASS PHARMACIES INC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 1128 N MAIN ST STE 3
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City | MADISONVILLE
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State | KY
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Zip | 42431-1265
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Country | US
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Telephone | 270-821-7335
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Fax | 270-821-7382
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Provider Business Mailing Address
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Address Line | 1128 N MAIN ST SUITE 3
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City | MADISONVILLE
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State | KY
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Zip | 42431-1265
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Country | US
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Telephone | 270-821-7335
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Fax | 270-821-7382
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Authorized Official
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Title or Position | PRESIDENT PHARMACIST
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Name | GARY RUSSELL
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Credential | RPH
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Telephone | 270-825-2775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy 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 | 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 #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | P07150
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License Number State | KY
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