Provider Demographics
NPI:1467676684
Name:CERTACARE PHARMACY
Entity Type:Organization
Organization Name:CERTACARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTAKE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-387-0023
Mailing Address - Street 1:150 WESTVIEW SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1600
Mailing Address - Country:US
Mailing Address - Phone:606-387-0023
Mailing Address - Fax:606-387-0024
Practice Address - Street 1:150 WESTVIEW SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1600
Practice Address - Country:US
Practice Address - Phone:606-387-0023
Practice Address - Fax:606-387-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP071813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1467676684OtherNPI
KY1467676684OtherNPI