Organization
CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
Active
Other names
Clover Fork Clinical Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRITT LEWIS JR. (ADMINISTRATOR)
(606) 837-2108
Entity
Organization
Contact information
Practice address
101 CHAD ST, EVARTS, KY 40828
(606) 837-2100
(606) 837-9389
Mailing address
PO BOX 39, EVARTS, KY 40828-0039
(606) 837-2108
(606) 837-9389
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P01273
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
P01273
KY
333600000X
Pharmacy
Primary
P01273
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54034913
—
KY
Enumeration date
07/23/2006
Last updated
10/21/2015
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