Organization
PRESCRIPTION SHOPPE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH RAY HOLLAND (OWNER)
(812) 254-7666
Entity
Organization
Contact information
Practice address
2005 STATE ST, STE B, WASHINGTON, IN 47501-8505
(812) 254-7666
Mailing address
PO BOX 714, WASHINGTON, IN 47501-0714
(812) 254-7666
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60003268A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100089430A
—
IN
Enumeration date
06/16/2006
Last updated
05/11/2009
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