Provider Demographics
NPI:1609995133
Name:GREENSBURG DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:GREENSBURG DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-387-0023
Mailing Address - Street 1:1911 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-7758
Mailing Address - Country:US
Mailing Address - Phone:270-932-2525
Mailing Address - Fax:270-932-2526
Practice Address - Street 1:1911 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-7758
Practice Address - Country:US
Practice Address - Phone:270-932-2525
Practice Address - Fax:270-932-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07151332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54000062Medicaid
KY54000062Medicaid