Provider Demographics
NPI:1629409180
Name:VERSAILLES INDEPENDENT PHARMACY, INC.
Entity Type:Organization
Organization Name:VERSAILLES INDEPENDENT PHARMACY, INC.
Other - Org Name:VERSAILLES INDEPENDENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-967-3794
Mailing Address - Street 1:296 PAYNES DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-9149
Mailing Address - Country:US
Mailing Address - Phone:859-967-3794
Mailing Address - Fax:
Practice Address - Street 1:166 FRANKFORT ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1164
Practice Address - Country:US
Practice Address - Phone:859-879-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP076013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143326OtherPK