Organization
CENTRAL CITY CLINIC PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH ANN GENTRY RPH (SECRETARY)
(270) 754-4300
Entity
Organization
Contact information
Practice address
203 N 2ND ST, CENTRAL CITY, KY 42330-1287
(270) 754-4300
(270) 754-9881
Mailing address
203 N 2ND ST, CENTRAL CITY, KY 42330-1287
(270) 754-4300
(270) 754-9881
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0290230001
MEDICARE
KY
01
—
1804031
NABP
KY
05
—
90040890
—
KY
01
—
P00339
STORE PERMIT #
KY
Enumeration date
03/08/2007
Last updated
07/24/2008
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