Provider Demographics
NPI:1639337579
Name:RX DISCOUNT PHARMACY OF HARLAN INC
Entity Type:Organization
Organization Name:RX DISCOUNT PHARMACY OF HARLAN INC
Other - Org Name:RX DISCOUNT PHARMACY #11
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANG
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-436-2407
Mailing Address - Street 1:PO BOX 1569
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1569
Mailing Address - Country:US
Mailing Address - Phone:606-436-2407
Mailing Address - Fax:606-436-0727
Practice Address - Street 1:79 WACO DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8327
Practice Address - Country:US
Practice Address - Phone:606-877-2414
Practice Address - Fax:606-877-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP072563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100045680Medicaid
KY1830682OtherNCPDP
KY1830682OtherNCPDP