Provider Demographics
NPI:1881839637
Name:FAMILY PHARMACY OF PERRY COUNTY LLC
Entity Type:Organization
Organization Name:FAMILY PHARMACY OF PERRY COUNTY LLC
Other - Org Name:FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:CHANEY
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-216-2962
Mailing Address - Street 1:PO BOX 2482
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-2482
Mailing Address - Country:US
Mailing Address - Phone:606-487-1150
Mailing Address - Fax:606-487-1160
Practice Address - Street 1:747 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9469
Practice Address - Country:US
Practice Address - Phone:606-487-1150
Practice Address - Fax:606-487-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP073083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1830911OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY7100060520Medicaid
KY1830911OtherNCPDP
KYP07308OtherPHARMACY PERMIT
KY6199990001Medicare NSC