MEDICARE: NICHOLASVILLE PHARMACY SERVICES 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1124755475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLASVILLE PHARMACY SERVICES INC

Provider Business Mailing Address
First Line	:	465 KEENE CENTRE DR
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-1492
Country	:	US
Telephone Number	:	859-887-2841
Fax Number	:

Provider Business Practice Location Address
First Line	:	465 KEENE CENTRE DR
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-1492
Country	:	US
Telephone Number	:	859-887-2841
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL DOWNS
Credential	:
Telephone Number	:	859-887-2841

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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