Provider Demographics
NPI:1689065856
Name:SUTTON DRUGS OF LA CENTER INC
Entity Type:Organization
Organization Name:SUTTON DRUGS OF LA CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RENFROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-665-5192
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:KY
Mailing Address - Zip Code:42056-0179
Mailing Address - Country:US
Mailing Address - Phone:270-665-5192
Mailing Address - Fax:270-665-9296
Practice Address - Street 1:234 BROADWAY
Practice Address - Street 2:
Practice Address - City:LA CENTER
Practice Address - State:KY
Practice Address - Zip Code:42056
Practice Address - Country:US
Practice Address - Phone:270-665-5192
Practice Address - Fax:270-665-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP01069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54014162Medicaid