Provider Demographics
NPI:1598890865
Name:HEALTHLINE PHARMACY LLC
Entity Type:Organization
Organization Name:HEALTHLINE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-698-3737
Mailing Address - Street 1:102 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095
Mailing Address - Country:US
Mailing Address - Phone:859-567-1772
Mailing Address - Fax:859-567-1773
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095
Practice Address - Country:US
Practice Address - Phone:859-567-1772
Practice Address - Fax:859-567-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06850332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145032201Medicaid
KY229794OtherBCBS
KY4125930001Medicare NSC