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General NPI Number Information
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NPI Number | 1659451177
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Entity Type | Organization
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Legal Business Name | TPN GRAYSON LLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 131 S CAROL MALONE BLVD STE E
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City | GRAYSON
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State | KY
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Zip | 41143-1810
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Country | US
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Telephone | 606-475-0232
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Fax | 606-475-0245
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Provider Business Mailing Address
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Address Line | 131 S CAROL MALONE BLVD STE E
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City | GRAYSON
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State | KY
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Zip | 41143-1810
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Country | US
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Telephone | 606-475-0232
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Fax | 606-475-0245
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Authorized Official
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Title or Position | PARTNER
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Name | DAREN WHITE
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Credential |
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Telephone | 859-277-2271
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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 | P07764
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License Number State | KY
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