Provider Demographics
NPI:1760883862
Name:POOLES PHARMACY CARE INC
Entity Type:Organization
Organization Name:POOLES PHARMACY CARE INC
Other - Org Name:POOLE'S PHARMACY CARE HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-543-3886
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:KY
Mailing Address - Zip Code:42352-0091
Mailing Address - Country:US
Mailing Address - Phone:270-278-5252
Mailing Address - Fax:270-278-2110
Practice Address - Street 1:104 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:KY
Practice Address - Zip Code:42352-2154
Practice Address - Country:US
Practice Address - Phone:270-278-5252
Practice Address - Fax:270-278-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP076483336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147779OtherPK
KY7100315020Medicaid