Provider Demographics
NPI:1578937694
Name:WEST KNOX PHARMACY, LLC
Entity Type:Organization
Organization Name:WEST KNOX PHARMACY, LLC
Other - Org Name:WEST KNOX PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-258-1111
Mailing Address - Street 1:485 NORVELL RD
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-6205
Mailing Address - Country:US
Mailing Address - Phone:606-304-1077
Mailing Address - Fax:
Practice Address - Street 1:14161 N US HIGHWAY 25 E
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6183
Practice Address - Country:US
Practice Address - Phone:606-258-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP077043336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155594OtherPK