Provider Demographics
NPI:1629464854
Name:B&B PHARMACY, PLLC
Entity Type:Organization
Organization Name:B&B PHARMACY, PLLC
Other - Org Name:B&B PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:502-543-8200
Mailing Address - Street 1:1578 HIGHWAY 44 E
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7172
Mailing Address - Country:US
Mailing Address - Phone:502-543-8200
Mailing Address - Fax:502-543-8500
Practice Address - Street 1:1578 HIGHWAY 44 E
Practice Address - Street 2:UNIT 1
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7172
Practice Address - Country:US
Practice Address - Phone:502-543-8200
Practice Address - Fax:502-543-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP076823336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100350160Medicaid