Provider Demographics
NPI:1316554975
Name:OWENSBORO PHARMACY, LLC
Entity Type:Organization
Organization Name:OWENSBORO PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:270-683-2400
Mailing Address - Street 1:720 W BYERS AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6330
Mailing Address - Country:US
Mailing Address - Phone:270-683-2400
Mailing Address - Fax:270-685-4825
Practice Address - Street 1:720 W BYERS AVE
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6330
Practice Address - Country:US
Practice Address - Phone:270-683-2400
Practice Address - Fax:270-685-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy