Provider Demographics
NPI:1942310289
Name:CARLISLE DRUG INC
Entity Type:Organization
Organization Name:CARLISLE DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES RPH
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-289-2528
Mailing Address - Street 1:126 E MAIN ST
Mailing Address - Street 2:CARLISLE DRUG INC
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-1154
Mailing Address - Country:US
Mailing Address - Phone:859-289-2528
Mailing Address - Fax:859-289-2246
Practice Address - Street 1:126 E MAIN ST
Practice Address - Street 2:CARLISLE DRUG INC
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-1154
Practice Address - Country:US
Practice Address - Phone:859-289-2528
Practice Address - Fax:859-289-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP00817333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS4006390Medicaid
1803964OtherNABP
AB3000267OtherDEA
KYS4006390Medicaid