Provider Demographics
NPI:1295805968
Name:JOHNS CREEK DRUG CENTER
Entity type:Organization
Organization Name:JOHNS CREEK DRUG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STARNES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-631-9137
Mailing Address - Street 1:P.O. BOX 2782
Mailing Address - Street 2:6162 ZEBULON HWAY
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502
Mailing Address - Country:US
Mailing Address - Phone:606-631-9137
Mailing Address - Fax:606-432-0983
Practice Address - Street 1:6162 ZEBULON HIGHWAY
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501
Practice Address - Country:US
Practice Address - Phone:606-631-9137
Practice Address - Fax:606-432-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54022249Medicaid
KYP02038OtherKY LICENSE #
KY1818155OtherNABP