MEDICARE: PHARMACY-CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000070102	OTHER	KY	DME

General Provider Information

NPI Number	:	1104824424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY-CENTER INC

Provider Business Mailing Address
First Line	:	803 BURKESVILLE ST
Second Line	:
City	:	COLUMBIA
State	:	KY
Zip	:	42728-1655
Country	:	US
Telephone Number	:	270-384-2117
Fax Number	:	270-384-5636

Provider Business Practice Location Address
First Line	:	803 BURKESVILLE ST
Second Line	:
City	:	COLUMBIA
State	:	KY
Zip	:	42728-1655
Country	:	US
Telephone Number	:	270-384-2117
Fax Number	:	270-384-5636

Authorized Official
Title or Position	:	OWNER
Name	:	BRITTAIN COLE JACKSON
Credential	:	PHARMD
Telephone Number	:	270-250-9800

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	10/28/2019

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Directions to “PHARMACY-CENTER INC ” Practice Location

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