Organization
WEST TOWNE PHARMACY INC
Active
Other names
West Towne Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT MATHIS (OWNER/PIC)
(270) 443-0909
Entity
Organization
Contact information
Practice address
2755 W PARK DR, PADUCAH, KY 42001-9058
(270) 443-0909
(270) 443-5544
Mailing address
2755 W PARK DR, PADUCAH, KY 42001-9058
(270) 443-0909
(270) 443-5544
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P07652
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148441
PK
—
Enumeration date
05/27/2005
Last updated
07/01/2015
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