MEDICARE: BEREA DRUG CO 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
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	P07379	KY

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	2028583	OTHER		PK

General Provider Information

NPI Number	:	1750308730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEREA DRUG CO INC

Provider Business Mailing Address
First Line	:	402 RICHMOND RD N
Second Line	:	STE A
City	:	BEREA
State	:	KY
Zip	:	40403-1133
Country	:	US
Telephone Number	:	859-986-4521
Fax Number	:	859-985-0839

Provider Business Practice Location Address
First Line	:	402 RICHMOND RD N
Second Line	:	STE A
City	:	BEREA
State	:	KY
Zip	:	40403-1133
Country	:	US
Telephone Number	:	859-986-4521
Fax Number	:	859-985-0839

Authorized Official
Title or Position	:	OWNER, PIC
Name	:	ROBERT LITTLE
Credential	:	RPH
Telephone Number	:	859-986-4521

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	02/27/2025

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Directions to “BEREA DRUG CO INC ” Practice Location

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