Provider Demographics
NPI:1104824424
Name:PHARMACY-CENTER INC
Entity Type:Organization
Organization Name:PHARMACY-CENTER INC
Other - Org Name:COLUMBIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTAIN
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-250-9800
Mailing Address - Street 1:803 BURKESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1655
Mailing Address - Country:US
Mailing Address - Phone:270-384-2117
Mailing Address - Fax:270-384-5636
Practice Address - Street 1:803 BURKESVILLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1655
Practice Address - Country:US
Practice Address - Phone:270-384-2117
Practice Address - Fax:270-384-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
KYPO1780332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90090010Medicaid
KY000000070102OtherDME
KY90090010Medicaid