Provider Demographics
NPI:1689779431
Name:C&C DRUGS
Entity Type:Organization
Organization Name:C&C DRUGS
Other - Org Name:HOLBROOK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMICIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MADISON
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-784-4784
Mailing Address - Street 1:208 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1620
Mailing Address - Country:US
Mailing Address - Phone:606-784-4784
Mailing Address - Fax:606-784-5858
Practice Address - Street 1:208 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1620
Practice Address - Country:US
Practice Address - Phone:606-784-4784
Practice Address - Fax:606-784-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP01569332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5401843700Medicaid
KY5401843700Medicaid