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General NPI Number Information
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NPI Number | 1225472343
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Entity Type | Organization
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Legal Business Name | CIA DRUG LLC
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 208 E MAIN ST
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City | MOREHEAD
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State | KY
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Zip | 40351-1620
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Country | US
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Telephone | 606-784-4784
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Fax | 606-784-5858
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Provider Business Mailing Address
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Address Line | 208 E MAIN ST
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City | MOREHEAD
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State | KY
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Zip | 40351-1620
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Country | US
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Telephone | 606-784-4784
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Fax | 606-784-5858
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | JANE INGRAM
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Credential |
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Telephone | 606-784-4784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07563
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License Number State | KY
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