Provider Demographics
NPI:1255488300
Name:MED-COE INC
Entity Type:Organization
Organization Name:MED-COE INC
Other - Org Name:PURE DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEM
Authorized Official - Middle Name:
Authorized Official - Last Name:COE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-487-5468
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-0368
Mailing Address - Country:US
Mailing Address - Phone:270-487-5468
Mailing Address - Fax:270-487-0518
Practice Address - Street 1:805 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1002
Practice Address - Country:US
Practice Address - Phone:270-487-5468
Practice Address - Fax:270-487-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYPO71873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1808609OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1808609OtherNCPDP PROVIDER IDENTIFICATION NUMBER