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General NPI Number Information
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NPI Number | 1407043565
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Entity Type | Organization
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Legal Business Name | BROADWAY CLINIC PHARMACY INC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 280 RUSSELL RD
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City | ASHLAND
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State | KY
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Zip | 41101-7048
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Country | US
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Telephone | 606-324-6337
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Fax | 606-324-0533
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Provider Business Mailing Address
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Address Line | 515 BROADWAY AVE
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City | PAINTVILLE
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State | KY
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Zip | 41101
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Country | US
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Telephone | 606-789-9988
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Fax | 606-789-7619
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN WILLIAM
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Credential |
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Telephone | 606-324-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07212
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License Number State | KY
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