Provider Demographics
NPI:1356009021
Name:STULTZ PHARMACY INC
Entity Type:Organization
Organization Name:STULTZ PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:STULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-473-7346
Mailing Address - Street 1:1615 ASHLAND RD
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-1207
Mailing Address - Country:US
Mailing Address - Phone:606-473-7346
Mailing Address - Fax:606-473-5667
Practice Address - Street 1:1615 ASHLAND RD
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1207
Practice Address - Country:US
Practice Address - Phone:606-473-7346
Practice Address - Fax:606-473-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100198150Medicaid