Provider Demographics
NPI:1881611499
Name:BPRS INC
Entity type:Organization
Organization Name:BPRS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAAL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RPH
Authorized Official - Phone:859-491-1700
Mailing Address - Street 1:201 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:KY
Mailing Address - Zip Code:41074-1575
Mailing Address - Country:US
Mailing Address - Phone:859-491-1700
Mailing Address - Fax:859-491-7680
Practice Address - Street 1:201 6TH AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:KY
Practice Address - Zip Code:41074
Practice Address - Country:US
Practice Address - Phone:859-491-1700
Practice Address - Fax:859-491-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
KYP067663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54003652Medicaid
2033832OtherPK
KY9000 5182Medicaid
4521950001Medicare NSC