Provider Demographics
NPI:1366473621
Name:WILDCAT PHARMACIST GROUP LLC
Entity Type:Organization
Organization Name:WILDCAT PHARMACIST GROUP LLC
Other - Org Name:HUBBARD AND CURRY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-333-8462
Mailing Address - Street 1:2387 PROFESSIONAL HEIGHTS DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3004
Mailing Address - Country:US
Mailing Address - Phone:859-278-8408
Mailing Address - Fax:859-278-5948
Practice Address - Street 1:2387 PROFESSIONAL HEIGHTS DR STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3004
Practice Address - Country:US
Practice Address - Phone:859-278-8408
Practice Address - Fax:859-278-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
KYP065503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2028814OtherPK
KY54001755Medicaid
KY54001755Medicaid