Provider Demographics
NPI:1477187334
Name:BARBOURVILLE PRESCRIPTION CENTER, LLC
Entity Type:Organization
Organization Name:BARBOURVILLE PRESCRIPTION CENTER, LLC
Other - Org Name:BARBOURVILLE PRESCRIPTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:THIES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-599-3500
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5390
Mailing Address - Country:US
Mailing Address - Phone:606-546-6337
Mailing Address - Fax:606-546-6339
Practice Address - Street 1:1881 SOUTH U.S. HIGHWAY 25E
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906
Practice Address - Country:US
Practice Address - Phone:606-546-6337
Practice Address - Fax:606-546-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy