Provider Demographics
NPI:1073288544
Name:EASTRIDGE-PHELPS PHARMACY LLC
Entity Type:Organization
Organization Name:EASTRIDGE-PHELPS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-299-2333
Mailing Address - Street 1:500 N BYPASS RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-7792
Mailing Address - Country:US
Mailing Address - Phone:270-789-0577
Mailing Address - Fax:270-789-0578
Practice Address - Street 1:500 N BYPASS RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-7792
Practice Address - Country:US
Practice Address - Phone:270-789-0577
Practice Address - Fax:270-789-0578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTRIDGE-PHELPS PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy