Provider Demographics
NPI:1619950615
Name:DUNAWAY DRUG STORES, INC.
Entity Type:Organization
Organization Name:DUNAWAY DRUG STORES, INC.
Other - Org Name:DUNAWAY'S IMPERIAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-826-6565
Mailing Address - Street 1:110 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2993
Mailing Address - Country:US
Mailing Address - Phone:270-826-6565
Mailing Address - Fax:270-830-0083
Practice Address - Street 1:110 3RD ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2993
Practice Address - Country:US
Practice Address - Phone:270-826-6565
Practice Address - Fax:270-830-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
KY846333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4500168200Medicaid
000000069757OtherBCBS
KY5401241400Medicaid
KY9010051200Medicaid
KY4500168200Medicaid