Organization
LEWIS COUNTY PRIMARY CARE CENTER, INC.
Active
Other names
South Shore Family Health Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD EVANS PHARMD (DIRECTOR OF PHARMACY)
(606) 956-0188
Entity
Organization
Contact information
Practice address
142 DEPOT DR, SOUTH SHORE, KY 41175-9306
(606) 932-2138
(606) 932-2120
Mailing address
142 DEPOT DR, SOUTH SHORE, KY 41175-9306
(606) 932-2138
(606) 932-2120
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07791
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0189046
—
OH
01
—
2164227
PK
—
05
—
7100442910
—
KY
Enumeration date
09/23/2016
Last updated
04/04/2017
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