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General NPI Number Information
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NPI Number | 1629559224
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Entity Type | Organization
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Legal Business Name | VILLAGEMD CLINICALS PHARMACY KENTUCKY
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 05/14/2020
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Provider Practice Location Address
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Address Line | 1000 S 12TH ST STE A
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City | MURRAY
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State | KY
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Zip | 42071
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Country | US
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Telephone | 270-767-6960
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 S 12TH ST STE A
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City | MURRAY
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State | KY
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Zip | 42071-9303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | DAVID KOON
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Credential |
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Telephone | 346-980-2142
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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 | P08013
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License Number State | KY
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