Provider Demographics
NPI:1710066808
Name:FOGLE, DARREN SHANE (RPH)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:SHANE
Last Name:FOGLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1496
Mailing Address - Country:US
Mailing Address - Phone:270-775-4430
Mailing Address - Fax:270-754-9881
Practice Address - Street 1:101 LEGION DR
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1496
Practice Address - Country:US
Practice Address - Phone:270-754-4300
Practice Address - Fax:270-754-9881
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist