Provider Demographics
NPI:1205849841
Name:SUTTON PHARMACY, INC.
Entity Type:Organization
Organization Name:SUTTON PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-792-4611
Mailing Address - Street 1:330 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-1058
Mailing Address - Country:US
Mailing Address - Phone:859-792-4611
Mailing Address - Fax:859-792-3511
Practice Address - Street 1:330 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-1058
Practice Address - Country:US
Practice Address - Phone:859-792-4611
Practice Address - Fax:859-792-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO7829332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54013875Medicaid
KY90020405OtherKY MEDICAID DME
KY54013875Medicaid