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General NPI Number Information
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NPI Number | 1396975223
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Entity Type | Organization
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Legal Business Name | RX DISCOUNT OF BEREA PLLC
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 102 PRINCE ROYAL DR STE 2
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City | BEREA
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State | KY
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Zip | 40403-1468
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Country | US
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Telephone | 859-985-7283
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Fax | 859-985-0413
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Provider Business Mailing Address
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Address Line | 102 PRINCE ROYAL DR SUITE 2
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City | BEREA
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State | KY
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Zip | 40403-1468
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Country | US
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Telephone | 859-985-7283
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Fax | 859-985-0413
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Authorized Official
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Title or Position | PHARMACIST
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Name | LONNIE HUBBARD
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Credential |
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Telephone | 606-862-8261
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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 | 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 #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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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 | P07354
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License Number State | KY
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