Provider Demographics
NPI:1407199854
Name:CENTRAL KENTUCKY PHARMACY INC
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY PHARMACY INC
Other - Org Name:CRUME DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-507-5489
Mailing Address - Street 1:111 W FLAGET ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1422
Mailing Address - Country:US
Mailing Address - Phone:502-348-3938
Mailing Address - Fax:502-348-3434
Practice Address - Street 1:111 W FLAGET ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1422
Practice Address - Country:US
Practice Address - Phone:502-348-3938
Practice Address - Fax:502-348-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP075673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139862OtherPK