Organization
CROFTON PHARMACY, LLC
Active
Other names
CROFTON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHAN FULLER (OWNER)
(270) 775-2771
Entity
Organization
Contact information
Practice address
110 E MAIN ST, CROFTON, KY 42217-8288
(270) 424-8965
(270) 424-8965
Mailing address
PO BOX 126, BEAVER DAM, KY 42320-0126
(270) 424-8965
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
P07729
KY
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155592
PK
—
05
—
54017355
—
KY
Enumeration date
12/07/2015
Last updated
12/07/2015
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