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General NPI Number Information
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NPI Number | 1487766614
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Entity Type | Organization
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Legal Business Name | LEWIS COUNTY PRIMARY CARE CENTER PHARMACY
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 211 KY 59
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City | VANCEBURG
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State | KY
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Zip | 41179-0550
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Country | US
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Telephone | 606-796-2686
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Fax | 606-796-6010
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | VANCEBURG
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State | KY
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Zip | 41179-0550
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Country | US
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Telephone | 606-796-2686
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Fax | 606-796-6010
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Authorized Official
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Title or Position | PHARMACIST
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Name | LORIE EVANS
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Credential | PHARMD
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Telephone | 606-796-2686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | P07030
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License Number State | KY
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