Provider Demographics
NPI:1477938199
Name:SAV RITE FAMILY PHARMACY SOUTH INC
Entity Type:Organization
Organization Name:SAV RITE FAMILY PHARMACY SOUTH INC
Other - Org Name:SAV-RITE PHARMACY SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-802-2636
Mailing Address - Street 1:5418 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-6063
Mailing Address - Country:US
Mailing Address - Phone:606-802-2636
Mailing Address - Fax:606-802-2635
Practice Address - Street 1:5418 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6063
Practice Address - Country:US
Practice Address - Phone:606-802-2636
Practice Address - Fax:606-802-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP077033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100435970Medicaid
2153317OtherPK
KY7100370080Medicaid