Provider Demographics
NPI:1487225918
Name:SALYERSVILLE PHARMACIST GROUP LLC
Entity Type:Organization
Organization Name:SALYERSVILLE PHARMACIST GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:859-585-1854
Mailing Address - Street 1:125 FOXGLOVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9735
Mailing Address - Country:US
Mailing Address - Phone:859-585-1854
Mailing Address - Fax:
Practice Address - Street 1:660 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2182
Practice Address - Country:US
Practice Address - Phone:859-605-2057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy