Provider Demographics
NPI:1851925986
Name:BARDWELL PHARMACY LLC
Entity Type:Organization
Organization Name:BARDWELL PHARMACY LLC
Other - Org Name:BARDWELL PHARMACY DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-628-5445
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:BARDWELL
Mailing Address - State:KY
Mailing Address - Zip Code:42023-0335
Mailing Address - Country:US
Mailing Address - Phone:270-628-5445
Mailing Address - Fax:270-628-3179
Practice Address - Street 1:178 US HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BARDWELL
Practice Address - State:KY
Practice Address - Zip Code:42023-9096
Practice Address - Country:US
Practice Address - Phone:270-628-5445
Practice Address - Fax:270-628-3179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARDWELL PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy