Organization
BROADWAY CLINIC PHARMACY INC
Active
Other names
MEDICINE CABINET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN WILLIAM (PRESIDENT)
(606) 324-6337
Entity
Organization
Contact information
Practice address
280 RUSSELL RD, ASHLAND, KY 41101-7048
(606) 324-6337
(606) 324-0533
Mailing address
515 BROADWAY AVE, PAINTVILLE, KY 41101
(606) 789-9988
(606) 789-7619
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07212
KY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1830353
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/02/2007
Last updated
07/18/2011
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