=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497754923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL KENTUCKY APOTHECARY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2005
-----------------------------------------------------
Last Update Date | 12/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E CUMBERLAND ST
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42602-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-387-6444
-----------------------------------------------------
Fax | 606-387-9224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 E CUMBERLAND ST
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42602-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-387-6444
-----------------------------------------------------
Fax | 606-387-9224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO/OWNER
-----------------------------------------------------
Name | ARICA V. COLLINS
-----------------------------------------------------
Credential | PHARM D.
-----------------------------------------------------
Telephone | 606-387-6444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | P07288
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | P07288
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------