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General NPI Number Information
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NPI Number | 1306088240
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Entity Type | Organization
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Legal Business Name | GRANT COUNTY DRUGS-NORTH
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 375 VIOLET RD
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City | CRITTENDEN
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State | KY
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Zip | 41030-8535
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Country | US
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Telephone | 859-428-3784
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Fax | 859-428-0595
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Provider Business Mailing Address
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Address Line | 24 S MAIN ST P.O. BOX 106
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City | DRY RIDGE
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State | KY
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Zip | 41035-7329
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Country | US
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Telephone | 859-823-5271
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Fax | 859-428-0595
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DR. ROBERT JASON WALLACE
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Credential | PHARM.D.,R.PH
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Telephone | 859-823-5271
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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 | P07334
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License Number State | KY
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