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General NPI Number Information
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NPI Number | 1598708836
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Entity Type | Organization
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Legal Business Name | JENNIE STUART MEDICAL CENTER
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 320 W 18TH ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1965
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Country | US
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Telephone | 270-887-0191
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Fax | 270-887-0201
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Provider Business Mailing Address
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Address Line | 1724 KENTON ST STE 1E
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1981
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Country | US
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Telephone | 270-887-0191
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Fax | 270-887-0201
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | PHIL FORT
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Credential |
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Telephone | 270-887-0191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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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 | P05034
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License Number State | KY
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