Provider Demographics
NPI:1619061025
Name:EUBANK INC
Entity Type:Organization
Organization Name:EUBANK INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EUBANK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-384-4474
Mailing Address - Street 1:920 JAMESTOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 JAMESTOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1012
Practice Address - Country:US
Practice Address - Phone:270-384-4474
Practice Address - Fax:270-384-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06687332B00000X
KYPO6687333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54002688Medicaid
1822089OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KYBT7369831OtherDEA #
KYBT7369831OtherDEA #