Provider Demographics
NPI:1154493542
Name:WHITEHEAD DRUGS INC
Entity Type:Organization
Organization Name:WHITEHEAD DRUGS INC
Other - Org Name:WHITEHEAD DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-637-1489
Mailing Address - Street 1:1502 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1711
Mailing Address - Country:US
Mailing Address - Phone:502-637-1489
Mailing Address - Fax:502-637-8766
Practice Address - Street 1:1502 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1711
Practice Address - Country:US
Practice Address - Phone:502-637-1489
Practice Address - Fax:502-637-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP063703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1802607OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY54033568Medicaid