Provider Demographics
NPI:1578693776
Name:FORT THOMAS DRUG CENTER II LLC
Entity Type:Organization
Organization Name:FORT THOMAS DRUG CENTER II LLC
Other - Org Name:FORT THOMAS DRUG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SEITHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-581-9355
Mailing Address - Street 1:26 N FORT THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1565
Mailing Address - Country:US
Mailing Address - Phone:859-441-1140
Mailing Address - Fax:859-572-8293
Practice Address - Street 1:26 N FORT THOMAS AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1565
Practice Address - Country:US
Practice Address - Phone:859-441-1140
Practice Address - Fax:859-572-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
KYP072053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100020710Medicaid
2030533OtherPK
6087930001Medicare NSC