MEDICARE: TRICARE PHARMACY NETWORK

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	333600000X	Pharmacy	P06668	KY
2	3336C0004X	Compounding Pharmacy	P06668	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1826948	OTHER		NCPDP
2	P06668	OTHER	KY	PHARMACY PERMIT

General Provider Information

NPI Number	:	1245366608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICARE PHARMACY NETWORK

Provider Business Mailing Address
First Line	:	1051 NEWTOWN PIKE STE 140
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-1245
Country	:	US
Telephone Number	:	859-277-2271
Fax Number	:	859-277-1532

Provider Business Practice Location Address
First Line	:	1051 NEWTOWN PIKE STE 140
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-1245
Country	:	US
Telephone Number	:	859-277-2271
Fax Number	:	859-277-1532

Authorized Official
Title or Position	:	OWNER
Name	:	DAREN WHITE
Credential	:	RPH
Telephone Number	:	859-277-2271

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	03/07/2023

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Directions to “TRICARE PHARMACY NETWORK ” Practice Location

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