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General NPI Number Information
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NPI Number | 1790082923
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Entity Type | Organization
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Legal Business Name | EAST KENTUCKY PHARMACY INC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 588 HIGHWAY 899
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City | HINDMAN
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State | KY
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Zip | 41822-8955
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Country | US
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Telephone | 606-785-3784
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Fax | 606-785-4510
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Provider Business Mailing Address
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Address Line | PO BOX 13
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City | MALLIE
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State | KY
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Zip | 41836-0013
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Country | US
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Telephone | 606-785-3784
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Fax | 606-785-4510
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Authorized Official
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Title or Position | PRESIDENT, PIC
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Name | KENNETH BOGGS
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Credential | RPH
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Telephone | 606-785-3784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07441
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License Number State | KY
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