Provider Demographics
NPI:1578748695
Name:COLLEGE SQUARE PHARMACY
Entity Type:Organization
Organization Name:COLLEGE SQUARE PHARMACY
Other - Org Name:KNIGHT'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-985-0516
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:191 GLADES RD
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-3018
Mailing Address - Country:US
Mailing Address - Phone:859-986-0500
Mailing Address - Fax:859-986-0505
Practice Address - Street 1:191 GLADES RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1369
Practice Address - Country:US
Practice Address - Phone:859-986-0500
Practice Address - Fax:859-986-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9000838400Medicaid