Organization
TERRADISE PROPERTIES INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG COYLE R.PH. (OWNER)
(859) 238-0002
Entity
Organization
Contact information
Practice address
900 HUSTONVILLE RD, DANVILLE, KY 40422-2137
(859) 238-0002
(859) 936-2043
Mailing address
900 HUSTONVILLE RD, DANVILLE, KY 40422-2137
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PO6316
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PO6316
KY
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PO6316
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1824754
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
54032826
—
KY
05
—
90120114
—
KY
Enumeration date
11/15/2006
Last updated
08/18/2023
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