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General NPI Number Information
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NPI Number | 1740501543
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Entity Type | Organization
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Legal Business Name | MED-MART PHARMACY LLC
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 87 C V B DR
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City | LONDON
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State | KY
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Zip | 40741-1096
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Country | US
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Telephone | 606-878-1200
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Fax | 606-878-1214
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Provider Business Mailing Address
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Address Line | 87 CVB DR
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City | LONDON
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State | KY
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Zip | 40741
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Country | US
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Telephone | 606-878-1200
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Fax | 606-878-1214
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL SIZEMORE
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Credential |
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Telephone | 606-878-1200
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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 |
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License Number State |
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Taxonomy #2
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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 #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07400
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License Number State | KY
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