Provider Demographics
NPI:1295748309
Name:JAMES MEDICAL PHARMACY
Entity type:Organization
Organization Name:JAMES MEDICAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:270-465-8220
Mailing Address - Street 1:1545 CAMPBELLSVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-2262
Mailing Address - Country:US
Mailing Address - Phone:270-385-9600
Mailing Address - Fax:270-385-9631
Practice Address - Street 1:1545 CAMPBELLSVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-2262
Practice Address - Country:US
Practice Address - Phone:270-385-9600
Practice Address - Fax:270-385-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYPO6424333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54000179Medicaid
KY7100105650Medicaid
KY5915750001Medicare NSC