Provider Demographics
NPI:1396975223
Name:RX DISCOUNT OF BEREA PLLC
Entity type:Organization
Organization Name:RX DISCOUNT OF BEREA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-862-8261
Mailing Address - Street 1:102 PRINCE ROYAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1468
Mailing Address - Country:US
Mailing Address - Phone:859-985-7283
Mailing Address - Fax:859-985-0413
Practice Address - Street 1:102 PRINCE ROYAL DR STE 2
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1468
Practice Address - Country:US
Practice Address - Phone:859-985-7283
Practice Address - Fax:859-985-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
KYP073543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121292OtherPK
KY7100083880Medicaid
6422530001Medicare NSC