Provider Demographics
NPI:1346513397
Name:FLOYD, VIRGINIA SUE (RPH)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SUE
Last Name:FLOYD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 ALASTAIR DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2566
Mailing Address - Country:US
Mailing Address - Phone:270-827-8453
Mailing Address - Fax:
Practice Address - Street 1:110 3RD ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2993
Practice Address - Country:US
Practice Address - Phone:270-826-6565
Practice Address - Fax:270-830-0083
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54012414Medicaid
KY54012414Medicaid