Organization
MADISON SOUTH PHARMACY LLC
Active
Organization
MADISON SOUTH PHARMACY LLC
Active
Other names
Madison South Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GIBBS (OWNER)
(606) 258-0000
Entity
Organization
Contact information
Practice address
405 RICHMOND RD N, STE D, BEREA, KY 40403-2083
(859) 228-0010
(859) 228-0014
Mailing address
40 MOONBOW PLZ, STE 1, CORBIN, KY 40701-8982
(606) 258-0000
(606) 258-0003
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07271
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1830808
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/14/2008
Last updated
08/02/2012
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