Provider Demographics
NPI:1053331967
Name:PARADISE ENTERPRISES LLC
Entity Type:Organization
Organization Name:PARADISE ENTERPRISES LLC
Other - Org Name:TOWN HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-638-0370
Mailing Address - Street 1:100 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-7545
Mailing Address - Country:US
Mailing Address - Phone:606-638-0370
Mailing Address - Fax:606-638-0111
Practice Address - Street 1:115 TOWN HILL ROAD
Practice Address - Street 2:SUITE 19
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-0370
Practice Address - Fax:606-638-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X
KYP067863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1827508OtherNABP NUMBER
KY54003645Medicaid
KY54003645Medicaid