Provider Demographics
NPI:1497308431
Name:EASTRIDGE, JOHN R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:EASTRIDGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N BYPASS RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-7792
Mailing Address - Country:US
Mailing Address - Phone:270-789-0577
Mailing Address - Fax:270-789-0578
Practice Address - Street 1:500 N BYPASS RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-7792
Practice Address - Country:US
Practice Address - Phone:270-789-0577
Practice Address - Fax:270-789-0578
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0106213336C0003X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy