Provider Demographics
NPI:1457455412
Name:DRUG MART INC
Entity Type:Organization
Organization Name:DRUG MART INC
Other - Org Name:DRUG MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-553-4424
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40340-0189
Mailing Address - Country:US
Mailing Address - Phone:859-553-4424
Mailing Address - Fax:859-885-9518
Practice Address - Street 1:104 EDGEWOOD PLAZA DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1814
Practice Address - Country:US
Practice Address - Phone:859-885-6056
Practice Address - Fax:859-885-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP002743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90050576Medicaid
2029039OtherPK
0859370001Medicare NSC
1807493OtherOTHER ID NUMBER-COMMERCIAL NUMBER