Provider Demographics
NPI:1659382166
Name:CENTRAL DRUG CENTER
Entity Type:Organization
Organization Name:CENTRAL DRUG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-465-4137
Mailing Address - Street 1:102 CENTRAL SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1857
Mailing Address - Country:US
Mailing Address - Phone:270-465-4137
Mailing Address - Fax:270-465-9761
Practice Address - Street 1:102 CENTRAL SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1857
Practice Address - Country:US
Practice Address - Phone:270-465-4137
Practice Address - Fax:270-465-9761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007598183500000X
KYP01333333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54016290Medicaid
1812696OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1812696OtherOTHER ID NUMBER-COMMERCIAL NUMBER