Provider Demographics
NPI:1205577756
Name:LEXINGTON PHARMACIST GROUP LLC
Entity type:Organization
Organization Name:LEXINGTON PHARMACIST GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:LAKIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-365-2003
Mailing Address - Street 1:3344 PARTNER PL STE 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3574
Mailing Address - Country:US
Mailing Address - Phone:859-365-2003
Mailing Address - Fax:859-365-2004
Practice Address - Street 1:3344 PARTNER PL STE 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3574
Practice Address - Country:US
Practice Address - Phone:859-365-2003
Practice Address - Fax:859-365-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100819650Medicaid