Provider Demographics
NPI:1184668873
Name:CAVE CITY PRESCRIPTION CENTER INC
Entity Type:Organization
Organization Name:CAVE CITY PRESCRIPTION CENTER INC
Other - Org Name:CAVE CITY PRESCRIPTION CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-773-2252
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127-0596
Mailing Address - Country:US
Mailing Address - Phone:270-773-2252
Mailing Address - Fax:270-773-2236
Practice Address - Street 1:101 SOUTH DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127
Practice Address - Country:US
Practice Address - Phone:270-773-2252
Practice Address - Fax:270-773-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP01525333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131843OtherPK
1814828OtherNCPDP PROVIDER IDENTIFICATION NUMBER