Provider Demographics
NPI:1235642687
Name:DONELL'S TRI-CITY PHARMACY
Entity Type:Organization
Organization Name:DONELL'S TRI-CITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BUSROE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-505-5133
Mailing Address - Street 1:40 W HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:KY
Mailing Address - Zip Code:40806-8384
Mailing Address - Country:US
Mailing Address - Phone:606-573-4550
Mailing Address - Fax:606-573-4402
Practice Address - Street 1:18880 N US HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:KY
Practice Address - Zip Code:40823-8106
Practice Address - Country:US
Practice Address - Phone:606-505-5133
Practice Address - Fax:606-573-4402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONELLS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-08
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP-07864OtherKY BOARD OF PHARMACY PERMIT