Provider Demographics
NPI:1891792057
Name:RICK'S PHARMACY, INC.
Entity Type:Organization
Organization Name:RICK'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-443-7200
Mailing Address - Street 1:3001 SCHNEIDMAN RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3541
Mailing Address - Country:US
Mailing Address - Phone:270-443-7200
Mailing Address - Fax:270-443-8537
Practice Address - Street 1:3001 SCHNEIDMAN RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3541
Practice Address - Country:US
Practice Address - Phone:270-443-7200
Practice Address - Fax:270-443-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-02
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90380734332B00000X
KYPO6149333600000X, 3336H0001X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1823613OtherNABP#
KY90380734Medicaid
KY54030697Medicaid
KYFLU0269Medicare PIN
KY1051760001Medicare NSC