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Organization

EASTRIDGE-PHELPS PHARMACY LLC

Active
Other names
Eastridge-Phelps Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
CHAD PHELPS (PHARMACIST/PIC/MEMBER)
(270) 789-0577
Entity
Organization

Contact information

Practice address
101 WINSTON WAY, SUITE A, CAMPBELLSVILLE, KY 42718-4953
(270) 789-0577
(270) 789-0578
Mailing address
101 WINSTON WAY, SUITE A, CAMPBELLSVILLE, KY 42718-4953
(270) 789-0577
(270) 789-0578

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336C0003X
Community/Retail Pharmacy
Primary
P07325
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1831038
NCPDP PROVIDER IDENTIFICATION NUMBER
05
7100060880
KY
Enumeration date
01/31/2009
Last updated
03/05/2021
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