Provider Demographics
NPI:1578584504
Name:FAMILY PHARMACY OF GLASGOW,LLC
Entity Type:Organization
Organization Name:FAMILY PHARMACY OF GLASGOW,LLC
Other - Org Name:MEDICINE SHOPPE#428
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.,SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-390-0666
Mailing Address - Street 1:501 HAPPY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1539
Mailing Address - Country:US
Mailing Address - Phone:270-651-9168
Mailing Address - Fax:
Practice Address - Street 1:501 HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1539
Practice Address - Country:US
Practice Address - Phone:270-651-9168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO67943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1820960OtherNCPDP
KY54004031Medicaid
KY90008814Medicaid
KYPO6794OtherPHARMACY LICENSE
KYPO6794OtherPHARMACY LICENSE
KYPO6794OtherPHARMACY LICENSE