Provider Demographics
NPI:1497817381
Name:KY FOUR INC
Entity Type:Organization
Organization Name:KY FOUR INC
Other - Org Name:PRESCRIPTIONS PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-588-3517
Mailing Address - Street 1:450 W HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BADEN
Mailing Address - State:IL
Mailing Address - Zip Code:62265-1658
Mailing Address - Country:US
Mailing Address - Phone:618-588-3517
Mailing Address - Fax:618-588-4818
Practice Address - Street 1:450 W HANOVER ST
Practice Address - Street 2:
Practice Address - City:NEW BADEN
Practice Address - State:IL
Practice Address - Zip Code:62265-1658
Practice Address - Country:US
Practice Address - Phone:618-588-3517
Practice Address - Fax:618-588-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540112043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0310820002Medicare NSC