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General NPI Number Information
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NPI Number | 1346513710
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Entity Type | Organization
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Legal Business Name | LEWIS COUNTY PRIMARY CARE CENTER, INC.
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 520 ELIZAVILLE AVE
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City | FLEMINGSBURG
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State | KY
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Zip | 41041-1141
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Country | US
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Telephone | 606-845-0402
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Fax | 606-845-0422
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Provider Business Mailing Address
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Address Line | 520 ELIZAVILLE AVE
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City | FLEMINGSBURG
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State | KY
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Zip | 41041-1141
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Country | US
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Telephone | 606-845-0402
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Fax | 606-845-0422
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | CHAD EVANS
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Credential | PHARMD
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Telephone | 606-956-0188
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07461
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License Number State | KY
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