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General NPI Number Information
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NPI Number | 1750370912
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Entity Type | Organization
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Legal Business Name | COTTONGIM DRUG CO INC
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 300 S MAIN ST
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City | CORBIN
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State | KY
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Zip | 40701-1458
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Country | US
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Telephone | 606-528-1304
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Fax | 606-528-1305
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Provider Business Mailing Address
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Address Line | PO BOX 570
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City | CORBIN
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State | KY
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Zip | 40702-0570
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Country | US
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Telephone | 606-528-1304
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Fax | 606-528-1305
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Authorized Official
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Title or Position | SECRETARY PHARMACIST
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Name | DONALD ROLLINS
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Credential | BS IN PHARMACY
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Telephone | 606-528-1304
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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 | P00234
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License Number State | KY
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