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General NPI Number Information
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NPI Number | 1497828578
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Entity Type | Organization
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Legal Business Name | SAM'S PROFESSIONAL PHARMACY, INC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 2 KNOX PLZ
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City | BARBOURVILLE
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State | KY
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Zip | 40906-7300
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Country | US
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Telephone | 606-546-3317
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Fax | 606-546-3928
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Provider Business Mailing Address
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Address Line | PO BOX 1766
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City | BARBOURVILLE
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State | KY
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Zip | 40906-5766
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Country | US
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Telephone | 606-546-3317
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Fax | 606-546-3928
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SAMUEL MOORE
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Credential | PHARMD, RPH
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Telephone | 606-546-3317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | P06975
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | P06975
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License Number State | KY
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