Provider Demographics
NPI:1740397702
Name:PHARMACARE OF KY, INC
Entity type:Organization
Organization Name:PHARMACARE OF KY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECH/BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-7933
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962
Mailing Address - Country:US
Mailing Address - Phone:606-598-2432
Mailing Address - Fax:606-599-0508
Practice Address - Street 1:1668 HWY 421 SOUTH
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962
Practice Address - Country:US
Practice Address - Phone:606-598-2432
Practice Address - Fax:606-599-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0989530001332B00000X
KYP06136332B00000X, 333600000X, 3336H0001X
KY1824778333600000X
KY540320813336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1824778OtherNABP #
KY90080268Medicaid
KY54032081Medicaid
KY54032081Medicaid