Provider Demographics
NPI:1588007090
Name:PHARMACY SURGE UNIT #1
Entity Type:Organization
Organization Name:PHARMACY SURGE UNIT #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:MCFALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-227-2303
Mailing Address - Street 1:1228 US HIGHWAY 127 S
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4330
Mailing Address - Country:US
Mailing Address - Phone:502-227-2303
Mailing Address - Fax:502-227-2258
Practice Address - Street 1:808 NEWTOWN CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1230
Practice Address - Country:US
Practice Address - Phone:502-227-2303
Practice Address - Fax:502-227-2258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTUCKY PHARMACISTS ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-15
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO75543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy