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Organization

EAST MAIN STREET PHARMACY

Active
Other names
East Main Pharmacy LLC
Organization subpart
No

Provider details

NPI number
Authorized official
DACHEA WOOTON RPH (OWNER,PIC,AO)
(606) 487-0107
Entity
Organization

Contact information

Practice address
279 E MAIN ST, HAZARD, KY 41701-1920
(606) 487-0107
(606) 487-0104
Mailing address
PO BOX 2069, HAZARD, KY 41702-2069
(606) 487-0107
(606) 487-0104

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P07502
KY
3336C0004X
Compounding Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2134045
PK
05
7100206580
KY
Enumeration date
03/15/2012
Last updated
09/17/2015
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