Provider Demographics
NPI:1073534731
Name:OUR LADY OF BELLEFONTE HOSPITAL INC
Entity Type:Organization
Organization Name:OUR LADY OF BELLEFONTE HOSPITAL INC
Other - Org Name:MEDICAL PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JANCI
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-833-3510
Mailing Address - Street 1:700 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7062
Mailing Address - Country:US
Mailing Address - Phone:606-833-3510
Mailing Address - Fax:606-833-3624
Practice Address - Street 1:700 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7062
Practice Address - Country:US
Practice Address - Phone:606-833-3510
Practice Address - Fax:606-833-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP065273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030543OtherPK
KY54019252Medicaid