Provider Demographics
NPI:1609010404
Name:NICHOLASVILLE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:NICHOLASVILLE PHARMACY SERVICES INC
Other - Org Name:THE PRESCRIPTION PAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-887-2841
Mailing Address - Street 1:465 KEENE CENTRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-0000
Mailing Address - Country:US
Mailing Address - Phone:859-887-2841
Mailing Address - Fax:859-887-1340
Practice Address - Street 1:465 KEENE CENTRE DRIVE
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-0000
Practice Address - Country:US
Practice Address - Phone:859-887-2841
Practice Address - Fax:859-887-1340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICHOLASVILLE PHARMACY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-23
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90010570Medicaid
0204350001Medicare NSC