Provider Demographics
NPI:1497754923
Name:CENTRAL KENTUCKY APOTHECARY
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY APOTHECARY
Other - Org Name:DYER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARICA
Authorized Official - Middle Name:V
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:606-387-6444
Mailing Address - Street 1:100 E CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1206
Mailing Address - Country:US
Mailing Address - Phone:606-387-6444
Mailing Address - Fax:606-387-9224
Practice Address - Street 1:100 E CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1206
Practice Address - Country:US
Practice Address - Phone:606-387-6444
Practice Address - Fax:606-387-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07288332B00000X, 333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFLU0343OtherNGS-MEDICARE MASS IMMUNIZER
KY7100052570Medicaid
KY90020272Medicaid
KY6258950001Medicare NSC