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General NPI Number Information
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NPI Number | 1699721720
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Entity Type | Organization
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Legal Business Name | ISOM COMMUNITY PHARMACY INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 93 ISOM PLAZA
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City | ISOM
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State | KY
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Zip | 41824-9011
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Country | US
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Telephone | 606-633-9238
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250 93 ISOM PLAZA
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City | ISOM
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State | KY
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Zip | 41824-0250
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Country | US
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Telephone | 606-633-9238
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | SCOTT E. BURRIS
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Credential | RPH
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Telephone | 606-633-9238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | P06559
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License Number State | KY
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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 | P06559
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License Number State | KY
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