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General NPI Number Information
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NPI Number | 1750879524
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Entity Type | Organization
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Legal Business Name | BARDWELL PHARMACY LLC
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 178 US HWY 51N
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City | BARDWELL
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State | KY
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Zip | 42023
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Country | US
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Telephone | 270-628-5445
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Fax | 618-628-3179
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Provider Business Mailing Address
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Address Line | 178 US HWY 51N
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City | BARDWELL
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State | KY
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Zip | 42023
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Country | US
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Telephone | 270-628-5445
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Fax | 618-628-3179
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Authorized Official
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Title or Position | OWNER
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Name | CHRIS AUGUSTUS
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Credential |
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Telephone | 270-628-5445
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | P07718
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License Number State | KY
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