Provider Demographics
NPI:1235667064
Name:ELKHORN PHARMACIST GROUP
Entity Type:Organization
Organization Name:ELKHORN PHARMACIST GROUP
Other - Org Name:NICHOLS APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-498-0136
Mailing Address - Street 1:125 FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9735
Mailing Address - Country:US
Mailing Address - Phone:859-498-0136
Mailing Address - Fax:859-498-9037
Practice Address - Street 1:220 E ELKHORN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522-8558
Practice Address - Country:US
Practice Address - Phone:606-754-5076
Practice Address - Fax:606-754-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy