Organization
BARDWELL PHARMACY
Active
Other names
BARDWELL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BOAZ RPH (OWNER PHARMACIST)
(270) 628-5445
Entity
Organization
Contact information
Practice address
178 US HWY 51 N, BARDWELL, KY 42023
(270) 628-5445
(270) 628-3179
Mailing address
PO BOX 335, BARDWELL, KY 42023-0335
(270) 628-5445
(270) 628-3179
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06353
KY
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2030630
PK
—
05
—
54020524
—
KY
05
—
90011974
—
KY
Enumeration date
07/25/2006
Last updated
12/28/2015
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