| NPI | 1427141159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH KELLY JOHNSON President 270-692-4950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: KY 90006735) |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: KY 54019211) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: KY 45542818) | |
| 183500000X Pharmacist (Licence: KY 007247) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-08-16 |