=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417994005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KYVA INVESTMENTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 MEDICAL PLAZA LN SUITE B
-----------------------------------------------------
City | WHITESBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41858-7425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-633-1335
-----------------------------------------------------
Fax | 606-633-1339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 2ND ST PO BOX 280
-----------------------------------------------------
City | WHITESBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41858-7362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-633-8098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY/TREASURER
-----------------------------------------------------
Name | MR. DENNIS WAYNE FLEMING
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 606-633-8098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PO1132
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------