Provider Demographics
NPI:1023336419
Name:FAITH PHARMACY INC
Entity type:Organization
Organization Name:FAITH PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-509-3344
Mailing Address - Street 1:PO BOX 4058
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-4058
Mailing Address - Country:US
Mailing Address - Phone:606-509-6337
Mailing Address - Fax:606-509-6340
Practice Address - Street 1:140 ADAMS LN STE 500
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3085
Practice Address - Country:US
Practice Address - Phone:606-509-6337
Practice Address - Fax:606-509-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP074063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831999OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY7100136740Medicaid