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General NPI Number Information
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NPI Number | 1578937694
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Entity Type | Organization
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Legal Business Name | WEST KNOX PHARMACY, LLC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 14161 N US HIGHWAY 25 E
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City | CORBIN
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State | KY
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Zip | 40701-6183
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Country | US
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Telephone | 606-258-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 485 NORVELL RD
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City | CORBIN
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State | KY
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Zip | 40701-6205
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Country | US
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Telephone | 606-304-1077
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST IN CHARGE
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Name | JENNIFER LYNN BAKER
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Credential | PHARMD
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Telephone | 606-258-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07704
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License Number State | KY
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