Organization
COMMONWEALTH OF KENTUCKY
Active
Parent organization
COMMONWEALTH OF KENTUCKY
Other names
Western State Hospital Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMONWEALTH OF KENTUCKY
Authorized official
STEPHANIE CRAYCRAFT (DIRECTOR)
(502) 782-6243
Entity
Organization
Contact information
Practice address
2400 RUSSELLVILLE ROAD, HOPKINSVILLE, KY 42240
(270) 889-6025
(270) 889-5062
Mailing address
2400 RUSSELLVILLE ROAD, HOPKINSVILLE, KY 42240
(270) 889-6025
(270) 889-5062
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
—
KY
1835G0303X
Geriatric Pharmacist
—
KY
1835P1300X
Psychiatric Pharmacist
—
KY
3336L0003X
Long Term Care Pharmacy
P05010
KY
3336L0003X
Long Term Care Pharmacy
P06561
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54025598
—
KY
05
—
5402559800
—
KY
Enumeration date
03/21/2007
Last updated
07/08/2015
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