Provider Demographics
NPI:1174664619
Name:NEW ERA OF KENTUCKY, INC
Entity Type:Organization
Organization Name:NEW ERA OF KENTUCKY, INC
Other - Org Name:CORNERSTONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-873-3007
Mailing Address - Street 1:100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1214
Mailing Address - Country:US
Mailing Address - Phone:859-873-3007
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1214
Practice Address - Country:US
Practice Address - Phone:859-873-3007
Practice Address - Fax:859-879-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP065763336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54000898Medicaid