Provider Demographics
NPI:1801358601
Name:PIKEVILLE COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:PIKEVILLE COMMUNITY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYCE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHOFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-886-8546
Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:50 WEDDINGTON BRANCH RD STE B
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3296
Practice Address - Country:US
Practice Address - Phone:606-637-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIG SANDY HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy