Organization
GRASSROOTS PHARMACY PLLC
Active
Other names
Grassroots Pharmacy, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY ROBERTS RPH (OWNER/PIC/AO)
(859) 227-0707
Entity
Organization
Contact information
Practice address
2304 SIR BARTON WAY STE 195, LEXINGTON, KY 40509-2284
(859) 227-0707
(859) 263-1684
Mailing address
3121 ALTHORP WAY, LEXINGTON, KY 40509-2423
(859) 227-0707
(859) 263-1684
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07798
KY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2165793
PK
—
Enumeration date
10/17/2016
Last updated
11/16/2016
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