Provider Demographics
NPI:1326235276
Name:NORTH FORK VALLEY COMMUNITY HEALTH BOARD, INC
Entity Type:Organization
Organization Name:NORTH FORK VALLEY COMMUNITY HEALTH BOARD, INC
Other - Org Name:UK NORTH FORK VALLEY COMMUNITY HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:EAGLE
Authorized Official - Last Name:KINGERY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-439-1559
Mailing Address - Street 1:750 MORTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701
Mailing Address - Country:US
Mailing Address - Phone:606-439-3557
Mailing Address - Fax:606-436-6988
Practice Address - Street 1:750 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-1559
Practice Address - Fax:606-436-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07214333600000X, 3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy