Provider Demographics
NPI:1265853741
Name:OWEN PHARMACIST GROUP LLC
Entity type:Organization
Organization Name:OWEN PHARMACIST GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-286-2029
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-0717
Mailing Address - Country:US
Mailing Address - Phone:606-286-2029
Mailing Address - Fax:606-286-2307
Practice Address - Street 1:261 W. TOM T HALL BLVD.
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164
Practice Address - Country:US
Practice Address - Phone:606-286-2029
Practice Address - Fax:606-286-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100273600Medicaid