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General NPI Number Information
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NPI Number | 1336690122
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Entity Type | Organization
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Legal Business Name | GRASSROOTS PHARMACY PLLC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 2304 SIR BARTON WAY STE 195
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City | LEXINGTON
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State | KY
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Zip | 40509-2284
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Country | US
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Telephone | 859-227-0707
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Fax | 859-263-1684
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Provider Business Mailing Address
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Address Line | 3121 ALTHORP WAY
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City | LEXINGTON
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State | KY
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Zip | 40509-2423
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Country | US
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Telephone | 859-227-0707
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Fax | 859-263-1684
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Authorized Official
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Title or Position | OWNER/PIC/AO
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Name | SHELLEY ROBERTS
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Credential | RPH
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Telephone | 859-227-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07798
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License Number State | KY
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