Organization
DAUGHERTYS DRUG STORE INC
Active
Other names
DAUGHERTYS DRUG STORE INC
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY MATHENY RPH (PRESIDENT)
(606) 354-2222
Entity
Organization
Contact information
Practice address
4160 S HWY 27, PINE KNOT, KY 42635
(606) 354-2222
(606) 354-3830
Mailing address
PO BOX 548, PINE KNOT, KY 42635-0548
(606) 354-2222
(606) 354-3830
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P01040
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2029239
PK
—
05
—
54013933
—
KY
05
—
90007790
—
KY
Enumeration date
10/31/2005
Last updated
10/12/2016
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