Provider Demographics
NPI:1639190093
Name:POOLES PHARMACY CARE INC
Entity Type:Organization
Organization Name:POOLES PHARMACY CARE INC
Other - Org Name:POOLES PHARMACY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:270-754-1545
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:KY
Mailing Address - Zip Code:42352-0091
Mailing Address - Country:US
Mailing Address - Phone:270-278-2367
Mailing Address - Fax:270-278-2368
Practice Address - Street 1:102 W BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1538
Practice Address - Country:US
Practice Address - Phone:270-754-1545
Practice Address - Fax:270-754-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
KYPO60933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90110891Medicaid
KY54006341Medicaid
2031653OtherPK
KY90110891Medicaid