Provider Demographics
NPI:1720190671
Name:AMERICAS NUMBER ONE HEALTH STORE INC
Entity Type:Organization
Organization Name:AMERICAS NUMBER ONE HEALTH STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-821-8500
Mailing Address - Street 1:1913 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3353
Mailing Address - Country:US
Mailing Address - Phone:270-821-8500
Mailing Address - Fax:270-821-8396
Practice Address - Street 1:1913 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3353
Practice Address - Country:US
Practice Address - Phone:270-821-8500
Practice Address - Fax:270-821-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP070283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100216370Medicaid
2032178OtherPK
KY7100216390Medicaid
KY7100216370Medicaid