Organization
BLUEGRASS DRUG STORE PLLC
Active
Other names
Bluegrass Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
MARK TAYLOR (CO-OWNER/PIC)
(859) 236-3535
Entity
Organization
Contact information
Practice address
104 PONDER CT STE E&F, DANVILLE, KY 40422-9000
(859) 236-3535
(859) 236-3035
Mailing address
104 PONDER CT STE E&F, DANVILLE, KY 40422-9000
(859) 236-3535
(859) 236-3035
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P07500
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1832939
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/28/2012
Last updated
03/28/2012
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