Organization
ICKYMA LLC
Active
Other names
Bondurant's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC DANIEL BREWER (MEMBER)
(859) 254-8852
Entity
Organization
Contact information
Practice address
1465 VILLAGE DR, LEXINGTON, KY 40504-1614
(859) 254-8852
(859) 254-8853
Mailing address
949 TANBARK RD, LEXINGTON, KY 40515-1872
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P06879
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54005715
—
KY
Enumeration date
02/02/2007
Last updated
03/07/2023
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