Organization
COLEMANS DRUGSTORE INC
Active
Other names
COLEMANS DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED PENCE (PRESIDENT, OWNER,AO)
(606) 365-2164
Entity
Organization
Contact information
Practice address
105 W MAIN ST, STANFORD, KY 40484-1253
(606) 365-2164
(606) 365-1181
Mailing address
105 W MAIN ST, STANFORD, KY 40484-1253
(606) 365-2164
(606) 365-1181
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P00253
KY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2029134
PK
—
05
—
7100237110
—
KY
Enumeration date
08/31/2006
Last updated
03/01/2017
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