=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992139232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESCRIPTION SHOPPE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2013
-----------------------------------------------------
Last Update Date | 08/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 INDUSTRIAL PARK RD STE 1
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42743-1383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-634-0530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 INDUSTRIAL PARK RD STE 1
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42743-1383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-634-0530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MICHAEL LEE STEPHENS SR.
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 270-634-0530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------