Provider Demographics
NPI:1376544957
Name:RICK' S PHARMACY, INC.
Entity Type:Organization
Organization Name:RICK' S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-2022
Mailing Address - Street 1:2700 HC MATHIS DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-3704
Mailing Address - Country:US
Mailing Address - Phone:270-444-2022
Mailing Address - Fax:270-444-9758
Practice Address - Street 1:2700 HC MATHIS DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-3704
Practice Address - Country:US
Practice Address - Phone:270-444-2022
Practice Address - Fax:270-444-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO6857332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1827899OtherNABP# CP
KY90006826Medicaid
KY54004809Medicaid
KY90006826Medicaid
KYFLU0269Medicare PIN