Provider Demographics
NPI:1003810490
Name:KNOX PROFESSIONAL PHARMACY INC
Entity Type:Organization
Organization Name:KNOX PROFESSIONAL PHARMACY INC
Other - Org Name:KNOX PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-546-3171
Mailing Address - Street 1:511 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1330
Mailing Address - Country:US
Mailing Address - Phone:606-546-3171
Mailing Address - Fax:606-546-5022
Practice Address - Street 1:511 KNOX ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1330
Practice Address - Country:US
Practice Address - Phone:606-546-3171
Practice Address - Fax:606-546-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP010883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029231OtherPK
KY7100176380Medicaid
KY7100176370Medicaid
KY7100176380Medicaid