MEDICARE: BLUEGRASS DRUG CENTER, 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	3336C0003X	Community/Retail Pharmacy	P07452	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2130610	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922391739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS DRUG CENTER, INC.

Provider Business Mailing Address
First Line	:	835 W MAIN ST
Second Line	:
City	:	MADISON
State	:	IN
Zip	:	47250-3131
Country	:	US
Telephone Number	:	812-265-4621
Fax Number	:	812-273-6666

Provider Business Practice Location Address
First Line	:	325 HIGHWAY 42 E
Second Line	:
City	:	BEDFORD
State	:	KY
Zip	:	40006-7624
Country	:	US
Telephone Number	:	502-255-3540
Fax Number	:	502-255-3615

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	ERIK GROVE
Credential	:
Telephone Number	:	502-255-3540

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	03/30/2016

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Directions to “BLUEGRASS DRUG CENTER, INC. ” Practice Location

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