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General NPI Number Information
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NPI Number | 1386078004
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Entity Type | Organization
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Legal Business Name | GAMALIEL DRUG LLC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 405 W MAIN ST
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City | GAMALIEL
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State | KY
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Zip | 42140-8906
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Country | US
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Telephone | 270-457-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 405 W MAIN ST
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City | GAMALIEL
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State | KY
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Zip | 42140-8906
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Country | US
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Telephone | 270-457-4100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY CAITLIN BROWN
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Credential | PHARMD
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Telephone | 270-457-4100
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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 | KY
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