Organization
EASTRIDGE-PHELPS PHARMACY LLC
Active
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
Update your record
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