Provider Demographics
NPI:1164558912
Name:BETSY LAYNE PHARMACY INC
Entity Type:Organization
Organization Name:BETSY LAYNE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-478-9474
Mailing Address - Street 1:PO BOX 2159
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2159
Mailing Address - Country:US
Mailing Address - Phone:606-478-9474
Mailing Address - Fax:606-478-1000
Practice Address - Street 1:11155 US HWY 23 S
Practice Address - Street 2:
Practice Address - City:BETSY LAYNE
Practice Address - State:KY
Practice Address - Zip Code:41605-4160
Practice Address - Country:US
Practice Address - Phone:606-478-9474
Practice Address - Fax:606-478-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP076413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54017017Medicaid
KY0870350001Medicare ID - Type Unspecified