Provider Demographics
NPI:1609208396
Name:CPHARMA INC
Entity Type:Organization
Organization Name:CPHARMA INC
Other - Org Name:CULL FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,OWNER,AO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CULL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-484-3611
Mailing Address - Street 1:965 HIGHWAY 127 N
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-9302
Mailing Address - Country:US
Mailing Address - Phone:502-484-3046
Mailing Address - Fax:502-484-1032
Practice Address - Street 1:965 HIGHWAY 127 N
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-9302
Practice Address - Country:US
Practice Address - Phone:502-484-3046
Practice Address - Fax:502-484-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
KYP075863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141505OtherPK
KY7100260950Medicaid
7365880001Medicare NSC