Provider Demographics
NPI:1912282187
Name:CAMPTON PHARMACIST GROUP, LLC
Entity Type:Organization
Organization Name:CAMPTON PHARMACIST GROUP, LLC
Other - Org Name:WOLFE FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-668-2273
Mailing Address - Street 1:125 FOXGLOVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:066-668-2273
Mailing Address - Fax:606-668-7699
Practice Address - Street 1:797 KY 15 SOUTH
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301
Practice Address - Country:US
Practice Address - Phone:606-668-2273
Practice Address - Fax:606-668-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP074663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6978350001Medicare NSC