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General NPI Number Information
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NPI Number | 1447585336
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Entity Type | Organization
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Legal Business Name | ACE CLINIQUE PHARMACY
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 207 ROY CAMPBELL DR
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City | HAZARD
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State | KY
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Zip | 41701
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Country | US
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Telephone | 606-439-3223
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1629
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City | HAZARD
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State | KY
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Zip | 41702-1629
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Country | US
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Telephone | 606-439-3223
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MRS. LESA CHANEY
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Credential |
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Telephone | 606-439-3223
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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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