Provider Demographics
NPI:1073773503
Name:BIG SANDY PHARMACY
Entity Type:Organization
Organization Name:BIG SANDY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-789-5371
Mailing Address - Street 1:316 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1044
Mailing Address - Country:US
Mailing Address - Phone:606-789-5371
Mailing Address - Fax:606-789-3227
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1044
Practice Address - Country:US
Practice Address - Phone:606-789-5371
Practice Address - Fax:606-789-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYPO24413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90160581Medicaid