Provider Demographics
NPI:1679898712
Name:MARROWBONE HOMETOWN PHARMACY INC
Entity Type:Organization
Organization Name:MARROWBONE HOMETOWN PHARMACY INC
Other - Org Name:MARROWBONE HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-754-4633
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:REGINA
Mailing Address - State:KY
Mailing Address - Zip Code:41559-0250
Mailing Address - Country:US
Mailing Address - Phone:606-794-4612
Mailing Address - Fax:
Practice Address - Street 1:9613 MILLARD HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-8162
Practice Address - Country:US
Practice Address - Phone:606-754-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP073823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831797OtherNCPDP PROVIDER IDENTIFICATION NUMBER