Provider Demographics
NPI:1275575730
Name:COMPLETE CARE PHARMACY PLLC
Entity Type:Organization
Organization Name:COMPLETE CARE PHARMACY PLLC
Other - Org Name:COMPLETE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST / MEMBER PLIC
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-487-1910
Mailing Address - Street 1:572 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9473
Mailing Address - Country:US
Mailing Address - Phone:606-487-1910
Mailing Address - Fax:606-439-1196
Practice Address - Street 1:572 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9473
Practice Address - Country:US
Practice Address - Phone:606-487-1910
Practice Address - Fax:606-439-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP070673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2034183OtherPK
KY54008107Medicaid