Provider Demographics
NPI:1770864852
Name:ADAIR PHARMACY INC
Entity Type:Organization
Organization Name:ADAIR PHARMACY INC
Other - Org Name:GREEN RIVER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:SPURLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-787-2100
Mailing Address - Street 1:50 DILLON STREET
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-3392
Mailing Address - Country:US
Mailing Address - Phone:606-787-2100
Mailing Address - Fax:606-787-1874
Practice Address - Street 1:50 DILLON ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3470
Practice Address - Country:US
Practice Address - Phone:606-787-2100
Practice Address - Fax:606-787-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP075083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136933OtherPK
KY7100220260Medicaid
2136933OtherPK
1833323OtherNCPDP