Provider Demographics
NPI:1619154929
Name:BENTON DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:BENTON DISCOUNT PHARMACY INC
Other - Org Name:WESTERN KENTUCKY HOME MEDICAL EQPMT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-527-1521
Mailing Address - Street 1:2606 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025
Mailing Address - Country:US
Mailing Address - Phone:270-527-1521
Mailing Address - Fax:270-527-2801
Practice Address - Street 1:2606 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025
Practice Address - Country:US
Practice Address - Phone:270-527-1521
Practice Address - Fax:270-527-2801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENTON DISCOUNT PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-29
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0278332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90010794Medicaid
KY022130001Medicare PIN
KY90010794Medicaid