Provider Demographics
NPI:1437258811
Name:FLEMING DRUG LLC
Entity Type:Organization
Organization Name:FLEMING DRUG LLC
Other - Org Name:FLEMING DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-776-2592
Mailing Address - Street 1:RLC MANAGEMENT
Mailing Address - Street 2:125 FOXGLOVE DR
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:997 ELIZAVILLE AVE
Practice Address - Street 2:STE A
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-9210
Practice Address - Country:US
Practice Address - Phone:606-849-2626
Practice Address - Fax:606-849-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP070383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5401037600Medicaid
1829033OtherNCPDP PROVIDER IDENTIFICATION NUMBER