Provider Demographics
NPI:1902011802
Name:BARRY'S PHARMACY
Entity Type:Organization
Organization Name:BARRY'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRYE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-826-3957
Mailing Address - Street 1:700 N. GREEN ST.
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2951
Mailing Address - Country:US
Mailing Address - Phone:270-826-3957
Mailing Address - Fax:270-827-8446
Practice Address - Street 1:700 N. GREEN ST.
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2951
Practice Address - Country:US
Practice Address - Phone:270-826-3957
Practice Address - Fax:270-827-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO1544332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90030511Medicaid
KY0161670001Medicare NSC