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General NPI Number Information
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NPI Number | 1528237575
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Entity Type | Organization
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Legal Business Name | PASADENA PHARMACY
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 280 PASADENA DR
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City | LEXINGTON
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State | KY
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Zip | 40503-2925
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Country | US
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Telephone | 859-260-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 280 PASADENA DR
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City | LEXINGTON
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State | KY
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Zip | 40503-2925
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Country | US
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Telephone | 859-260-2469
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. GARY S HARRIS
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Credential | PHARMD
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Telephone | 859-260-2469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | P07228
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07228
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License Number State | KY
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