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General NPI Number Information
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NPI Number | 1295110526
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Entity Type | Organization
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Legal Business Name | PAT'S PHARMACY, INC.
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 498 W MAIN ST
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City | LEBANON
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State | KY
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Zip | 40033-1362
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Country | US
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Telephone | 270-692-4950
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Fax | 270-692-2320
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Provider Business Mailing Address
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Address Line | 498 W MAIN ST
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City | LEBANON
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State | KY
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Zip | 40033-1362
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Country | US
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Telephone | 270-692-4950
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH KELLY JOHNSON
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Credential |
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Telephone | 270-692-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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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 | P06177
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License Number State | KY
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Taxonomy #3
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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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