Provider Demographics
NPI:1336120138
Name:DANPRO HOLDINGS, LLC
Entity Type:Organization
Organization Name:DANPRO HOLDINGS, LLC
Other - Org Name:FAMILY DRUG OF WHEELWRIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-436-2407
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0735
Mailing Address - Country:US
Mailing Address - Phone:606-436-2407
Mailing Address - Fax:606-436-0727
Practice Address - Street 1:107 KY ROUTE 306
Practice Address - Street 2:
Practice Address - City:BYPRO
Practice Address - State:KY
Practice Address - Zip Code:41612-9711
Practice Address - Country:US
Practice Address - Phone:606-452-4134
Practice Address - Fax:606-452-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP01550333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100752970Medicaid
18-11264OtherNABP
KY7100324200Medicaid