Provider Demographics
NPI:1245320290
Name:MARROWBONE CLINIC PHARMACY
Entity type:Organization
Organization Name:MARROWBONE CLINIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-754-7085
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:REGINA
Mailing Address - State:KY
Mailing Address - Zip Code:41559-0225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10363 REGINA BELCHER HWY
Practice Address - Street 2:
Practice Address - City:REGINA
Practice Address - State:KY
Practice Address - Zip Code:41559
Practice Address - Country:US
Practice Address - Phone:606-754-7085
Practice Address - Fax:606-754-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X
KYPO13603336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1813042OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KY54016530Medicaid