Organization
BROADWAY CLINIC PHARMACY INC
Active
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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