Organization
CENTRAL CITY CLINIC PHARMACY, INC
Active
Other names
Clinic Pharmacy South
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND D GENTRY (PRESIDENT)
(270) 476-3600
Entity
Organization
Contact information
Practice address
3959 US HWY 41 S, BEECHMONT, KY 42323-0070
(270) 476-3600
(270) 476-3100
Mailing address
203 N 2ND ST, CENTRAL CITY, KY 42330-1287
(270) 476-3600
(270) 476-3100
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
P06265
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1824475
NABP
KY
05
—
54032167
—
KY
Enumeration date
07/07/2008
Last updated
03/07/2023
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