Provider Demographics
NPI:1659363398
Name:PRESCRIPTION SHOPPE
Entity Type:Organization
Organization Name:PRESCRIPTION SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-384-2132
Mailing Address - Street 1:808 JAMESTOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1010
Mailing Address - Country:US
Mailing Address - Phone:270-384-2132
Mailing Address - Fax:270-384-4541
Practice Address - Street 1:808 JAMESTOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1010
Practice Address - Country:US
Practice Address - Phone:270-384-2132
Practice Address - Fax:270-384-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90030016Medicaid
KY0335990001Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID