Provider Demographics
NPI:1023450186
Name:BLUEGRASS DRUG CENTER INC
Entity type:Organization
Organization Name:BLUEGRASS DRUG CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-265-4621
Mailing Address - Street 1:835 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3131
Mailing Address - Country:US
Mailing Address - Phone:812-265-4621
Mailing Address - Fax:812-273-6666
Practice Address - Street 1:8170 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSBURG
Practice Address - State:KY
Practice Address - Zip Code:40011-1467
Practice Address - Country:US
Practice Address - Phone:502-465-4003
Practice Address - Fax:502-465-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP075853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1023450186Medicaid
2141381OtherPK