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General NPI Number Information
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NPI Number | 1306918198
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Entity Type | Organization
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Legal Business Name | TERRADISE PROPERTIES INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 900 HUSTONVILLE RD
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City | DANVILLE
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State | KY
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Zip | 40422-2137
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Country | US
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Telephone | 859-238-0002
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Fax | 859-936-2043
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Provider Business Mailing Address
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Address Line | 900 HUSTONVILLE RD
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City | DANVILLE
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State | KY
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Zip | 40422-2137
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOUG COYLE
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Credential | R.PH.
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Telephone | 859-238-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | PO6316
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PO6316
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PO6316
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License Number State | KY
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