Provider Demographics
NPI:1710081773
Name:FLEMING PHARMACIST GROUP INC
Entity Type:Organization
Organization Name:FLEMING PHARMACIST GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-845-3421
Mailing Address - Street 1:209 S MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1203
Mailing Address - Country:US
Mailing Address - Phone:606-845-2101
Mailing Address - Fax:606-849-2633
Practice Address - Street 1:209 S MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1203
Practice Address - Country:US
Practice Address - Phone:606-845-2101
Practice Address - Fax:606-849-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
KYP022153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2031635OtherPK
KY7100209770Medicaid
KY7100211900Medicaid