Provider Demographics
NPI:1417994005
Name:KYVA INVESTMENTS
Entity Type:Organization
Organization Name:KYVA INVESTMENTS
Other - Org Name:WHITESBURG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:606-633-8098
Mailing Address - Street 1:27 2ND ST
Mailing Address - Street 2:PO BOX 280
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-7362
Mailing Address - Country:US
Mailing Address - Phone:606-633-8098
Mailing Address - Fax:
Practice Address - Street 1:246 MEDICAL PLAZA LN
Practice Address - Street 2:SUITE B
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7425
Practice Address - Country:US
Practice Address - Phone:606-633-1335
Practice Address - Fax:606-633-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO1132333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54014642Medicaid
KY9010067800Medicaid
1813701OtherNAPB #