Provider Demographics
NPI:1962488700
Name:BERINGER DRUG STORE, INC.
Entity Type:Organization
Organization Name:BERINGER DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-698-3737
Mailing Address - Street 1:102 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095-9300
Mailing Address - Country:US
Mailing Address - Phone:859-567-4678
Mailing Address - Fax:859-567-4674
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095-9300
Practice Address - Country:US
Practice Address - Phone:859-567-4678
Practice Address - Fax:859-567-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06107333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54033196Medicaid
TN4582049Medicaid
KY90020397Medicaid
KY90020397Medicaid