Provider Demographics
NPI:1841206638
Name:NORTONVILLE DRUG STORE INC
Entity Type:Organization
Organization Name:NORTONVILLE DRUG STORE INC
Other - Org Name:NORTONVILLE DRUG STORE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-686-8263
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:NORTONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42442-0967
Mailing Address - Country:US
Mailing Address - Phone:270-676-8268
Mailing Address - Fax:270-676-8205
Practice Address - Street 1:102 GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42442
Practice Address - Country:US
Practice Address - Phone:270-676-8268
Practice Address - Fax:270-676-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP021063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1819359OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY54023544Medicaid
KY90140542Medicaid
0471350002Medicare NSC