MEDICARE: PAT'S PHARMACY, 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	332B00000X	Durable Medical Equipment & Medical Supplies	90006735	KY
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	54019211	KY
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	45542818	KY
4	183500000X	Pharmacist	007247	KY
5	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	000000070377	OTHER	KY	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427141159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAT'S PHARMACY, INC.

Provider Business Mailing Address
First Line	:	498 W. MAIN ST.
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1362
Country	:	US
Telephone Number	:	270-692-4950
Fax Number	:	270-692-2320

Provider Business Practice Location Address
First Line	:	498 W. MAIN ST.
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1362
Country	:	US
Telephone Number	:	270-692-4950
Fax Number	:	270-692-2320

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH KELLY JOHNSON
Credential	:
Telephone Number	:	270-692-4950

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/16/2022

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Directions to “PAT'S PHARMACY, INC. ” Practice Location

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