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General NPI Number Information
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NPI Number | 1629409180
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Entity Type | Organization
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Legal Business Name | VERSAILLES INDEPENDENT PHARMACY, INC.
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 166 FRANKFORT ST
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City | VERSAILLES
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State | KY
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Zip | 40383-1164
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Country | US
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Telephone | 859-879-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 296 PAYNES DEPOT RD
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City | LEXINGTON
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State | KY
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Zip | 40511-9149
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Country | US
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Telephone | 859-967-3794
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Fax |
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Authorized Official
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Title or Position | OWNER/PIC
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Name | CARY WHITE
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Credential |
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Telephone | 859-967-3794
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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 | P07601
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License Number State | KY
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