Provider Demographics
NPI:1134228232
Name:ANDERSON COUNTY DSICOUNT PHARMACY
Entity type:Organization
Organization Name:ANDERSON COUNTY DSICOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-839-5147
Mailing Address - Street 1:506 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1306
Mailing Address - Country:US
Mailing Address - Phone:502-839-5147
Mailing Address - Fax:502-839-7155
Practice Address - Street 1:506 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1306
Practice Address - Country:US
Practice Address - Phone:502-839-5147
Practice Address - Fax:502-839-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP02132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54023684Medicaid