Provider Demographics
NPI:1760789861
Name:DRIVE IN PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:DRIVE IN PHARMACY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD L.
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:606-549-0812
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-0460
Mailing Address - Country:US
Mailing Address - Phone:606-549-0888
Mailing Address - Fax:606-549-3217
Practice Address - Street 1:688 S HIGHWAY 25 W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1697
Practice Address - Country:US
Practice Address - Phone:606-549-0888
Practice Address - Fax:606-549-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0497332B00000X
KYP07019333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100157900Medicaid
1832307OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY6481650001OtherPTAN MEDICARE DME SUPPLIER NSC