MEDICARE: BARRYS 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	P01544	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1809221	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1740291251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRYS PHARMACY INC

Provider Business Mailing Address
First Line	:	700 N GREEN ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2951
Country	:	US
Telephone Number	:	270-826-3957
Fax Number	:	270-827-8446

Provider Business Practice Location Address
First Line	:	700 N GREEN ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2951
Country	:	US
Telephone Number	:	270-826-3957
Fax Number	:	270-826-7767

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERRYE GOWER
Credential	:	RPH
Telephone Number	:	270-826-3957

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	01/06/2012

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