Provider Demographics
NPI:1073670352
Name:O J PHARMACY INC
Entity Type:Organization
Organization Name:O J PHARMACY INC
Other - Org Name:WALTER'S FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-7070
Mailing Address - Street 1:PO BOX 9245
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9245
Mailing Address - Country:US
Mailing Address - Phone:270-753-7688
Mailing Address - Fax:270-753-6782
Practice Address - Street 1:604 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2916
Practice Address - Country:US
Practice Address - Phone:270-753-7688
Practice Address - Fax:270-753-6782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP075133336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54018221Medicaid
2136544OtherPK