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General NPI Number Information
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NPI Number | 1841486156
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHARMACY OF SOMERSET LLC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 342 BOGLE ST
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City | SOMERSET
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State | KY
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Zip | 42503-2851
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Country | US
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Telephone | 606-679-1169
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Fax | 606-679-1049
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Provider Business Mailing Address
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Address Line | 342 BOGLE ST
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City | SOMERSET
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State | KY
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Zip | 42503-2851
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Country | US
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Telephone | 606-679-1169
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Fax | 606-679-1049
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Authorized Official
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Title or Position | OWNER
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Name | PAM DAULTON
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Credential |
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Telephone | 606-679-1169
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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 | 7100039650
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License Number State | KY
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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 | P07206
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07849
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License Number State | KY
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