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General NPI Number Information
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NPI Number | 1740893999
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Entity Type | Organization
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Legal Business Name | LEWIS COUNTY PRIMARY CARE CENTER, INC
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Dates
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Enumeration Date | 08/27/2020
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 645 INTERSTATE DRIVE
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City | GRAYSON
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State | KY
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Zip | 41143
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Country | US
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Telephone | 606-898-0209
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Fax | 606-898-0210
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Provider Business Mailing Address
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Address Line | 927 KENTON STATION DR
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City | MAYSVILLE
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State | KY
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Zip | 41056-9617
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Country | US
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Telephone | 606-759-1189
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | CHAD ERWIN EVANS
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Credential | PHARMD
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Telephone | 606-956-0188
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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 |
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License Number State |
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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 |
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License Number State |
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