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General NPI Number Information
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NPI Number | 1861267007
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Entity Type | Organization
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Legal Business Name | KENTUCKY MOUNTAIN HEALTH ALLIANCE
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 1908 N MAIN ST STE 240
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City | HAZARD
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State | KY
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Zip | 41701-2503
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Country | US
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Telephone | 606-487-9505
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Fax |
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Provider Business Mailing Address
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Address Line | 1908 N MAIN ST # 204
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City | HAZARD
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State | KY
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Zip | 41701-2505
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Country | US
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Telephone | 606-487-9505
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Fax |
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Authorized Official
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Title or Position | 340B COORDINATOR
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Name | REBECCA CHEEK
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Credential | PHARMD
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Telephone | 606-487-9505
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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 |
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License Number State |
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