Provider Demographics
NPI:1619063344
Name:MEDICINE STOP PHARMACY, INC.
Entity Type:Organization
Organization Name:MEDICINE STOP PHARMACY, INC.
Other - Org Name:MEDICINE STOP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARSHON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-803-1693
Mailing Address - Street 1:1339 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-1715
Mailing Address - Country:US
Mailing Address - Phone:859-987-4023
Mailing Address - Fax:859-987-0197
Practice Address - Street 1:1339 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-1715
Practice Address - Country:US
Practice Address - Phone:859-987-4023
Practice Address - Fax:859-987-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYPO72613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1819018OtherNCPDP
KY7100069840Medicaid
6302770001Medicare NSC