Provider Demographics
NPI:1508111782
Name:EAST KENTUCKY DRUG INC.
Entity Type:Organization
Organization Name:EAST KENTUCKY DRUG INC.
Other - Org Name:EAST KENTUCKY DRUG INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRES., SEC.
Authorized Official - Prefix:
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-639-2415
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:VIRGIE
Mailing Address - State:KY
Mailing Address - Zip Code:41572-0340
Mailing Address - Country:US
Mailing Address - Phone:606-639-2415
Mailing Address - Fax:606-639-3052
Practice Address - Street 1:160 CONN ST STE 2
Practice Address - Street 2:
Practice Address - City:IVEL
Practice Address - State:KY
Practice Address - Zip Code:41642-9406
Practice Address - Country:US
Practice Address - Phone:606-639-2415
Practice Address - Fax:606-639-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP075123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1833208OtherNCPDP PROVIDER IDENTIFICATION NUMBER