Provider Demographics
NPI:1588211080
Name:POOLES PHARMACY CARE INC
Entity Type:Organization
Organization Name:POOLES PHARMACY CARE INC
Other - Org Name:POOLE'S PHARMACY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-525-8517
Mailing Address - Street 1:8180 US HIGHWAY 60 W
Mailing Address - Street 2:
Mailing Address - City:LEWISPORT
Mailing Address - State:KY
Mailing Address - Zip Code:42351-7081
Mailing Address - Country:US
Mailing Address - Phone:270-295-3131
Mailing Address - Fax:270-295-3132
Practice Address - Street 1:8180 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351-7081
Practice Address - Country:US
Practice Address - Phone:270-295-3131
Practice Address - Fax:270-295-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100625410Medicaid