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General NPI Number Information
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NPI Number | 1407871288
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Entity Type | Organization
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Legal Business Name | BIG SANDY PHARMACY INC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 316 MAIN ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1044
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Country | US
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Telephone | 606-789-5371
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Fax | 606-789-3227
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Provider Business Mailing Address
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Address Line | 316 MAIN ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1044
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Country | US
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Telephone | 606-789-5371
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Fax | 606-789-3227
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Authorized Official
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Title or Position | PHARMACIST MANAGER
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Name | DAN SALYER
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Credential | R.PH
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Telephone | 606-789-5371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P02441
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License Number State | KY
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