Provider Demographics
NPI:1538297858
Name:G & O OF PADUCAH, INC
Entity Type:Organization
Organization Name:G & O OF PADUCAH, INC
Other - Org Name:G & O PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-442-3571
Mailing Address - Street 1:2338 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7114
Mailing Address - Country:US
Mailing Address - Phone:270-442-3571
Mailing Address - Fax:270-442-3197
Practice Address - Street 1:2338 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7114
Practice Address - Country:US
Practice Address - Phone:270-442-3571
Practice Address - Fax:270-442-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06961333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54005962Medicaid
KY90000233OtherDURABLE MEDICAL SUPLIES
KY54005962Medicaid