Provider Demographics
NPI:1225106057
Name:BLUEGRASS PHARMACIES INC
Entity Type:Organization
Organization Name:BLUEGRASS PHARMACIES INC
Other - Org Name:BLUEGRASS LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-825-2775
Mailing Address - Street 1:1128 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1265
Mailing Address - Country:US
Mailing Address - Phone:270-821-7335
Mailing Address - Fax:270-821-7382
Practice Address - Street 1:1128 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1265
Practice Address - Country:US
Practice Address - Phone:270-821-7335
Practice Address - Fax:270-821-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X
KYP071503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2034631OtherPK
KY54013016Medicaid
KY0401900001Medicare NSC