Provider Demographics
NPI:1114539822
Name:B&B PHARMACY, PLLC
Entity Type:Organization
Organization Name:B&B PHARMACY, PLLC
Other - Org Name:B&B PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:KRAJEWSKI
Authorized Official - Last Name:BARGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:502-543-8200
Mailing Address - Street 1:126 SHADOWMEADE LANE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047
Mailing Address - Country:US
Mailing Address - Phone:502-538-5000
Mailing Address - Fax:502-538-0330
Practice Address - Street 1:126 SHADOWMEADE LANE
Practice Address - Street 2:UNIT 2
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047
Practice Address - Country:US
Practice Address - Phone:502-538-5000
Practice Address - Fax:502-538-0330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B&B PHARMACY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100696040Medicaid