Provider Demographics
NPI:1639348550
Name:YOUR PHARMACY, LLC
Entity Type:Organization
Organization Name:YOUR PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-234-5400
Mailing Address - Street 1:208 W PLEASANT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-2421
Mailing Address - Country:US
Mailing Address - Phone:859-234-5400
Mailing Address - Fax:859-234-5399
Practice Address - Street 1:208 W PLEASANT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-2421
Practice Address - Country:US
Practice Address - Phone:859-234-5400
Practice Address - Fax:859-234-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90005174332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90005174Medicaid
1297420001Medicare NSC