Provider Demographics
NPI:1346375359
Name:BERINGER DRUG STORE INC
Entity Type:Organization
Organization Name:BERINGER DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-698-3737
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-0608
Mailing Address - Country:US
Mailing Address - Phone:859-567-4678
Mailing Address - Fax:859-567-4674
Practice Address - Street 1:102 WEST MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095
Practice Address - Country:US
Practice Address - Phone:859-567-4678
Practice Address - Fax:859-567-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06107332B00000X
KYPO61073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9002039700Medicaid
KY0000069795OtherBCBS
AR133453741Medicaid
OH2047056Medicaid
22885OtherABP
TN4582049Medicaid
KY5403319600OtherKYHEALTH CHOICES
AR133453741Medicaid