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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