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General NPI Number Information
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NPI Number | 1871255430
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Entity Type | Organization
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Legal Business Name | C D S 10 PHARMACY LLC
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 1308 ASHLEY CIRCLE
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City | BOWLING GREEN
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State | KY
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Zip | 42104
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Country | US
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Telephone | 270-779-0599
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Fax | 270-781-5652
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Provider Business Mailing Address
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Address Line | 1308 ASHLEY CIRCLE
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City | BOWLING GREEN
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State | KY
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Zip | 42104
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Country | US
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Telephone | 270-779-0599
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Fax | 270-781-5652
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JANE ELLEN LACEFIELD
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Credential | PHARMD
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Telephone | 270-781-5661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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