Provider Demographics
NPI:1447397864
Name:DOWNTOWN DRUG, INC.
Entity Type:Organization
Organization Name:DOWNTOWN DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-285-0786
Mailing Address - Street 1:90 TRIANGLE STREET
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-1369
Mailing Address - Country:US
Mailing Address - Phone:606-285-0786
Mailing Address - Fax:606-285-0646
Practice Address - Street 1:90 TRIANGLE STREET
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-1369
Practice Address - Country:US
Practice Address - Phone:606-285-0786
Practice Address - Fax:606-285-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6243332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90295361Medicaid
KY1824336OtherNCPDP
KY90295361Medicaid