Organization
BLUEGRASS MEDICAL SUPPLY INC TT
Active
Organization
BLUEGRASS MEDICAL SUPPLY INC TT
Active
Other names
The Medicine Shoppe #586
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS COYLE (PRESIDENT)
(859) 238-0002
Entity
Organization
Contact information
Practice address
636 S COLLEGE ST, HARRODSBURG, KY 40330-2142
(859) 734-4314
(859) 734-4370
Mailing address
900 HUSTONVILLE RD, DANVILLE, KY 40422-2137
(859) 516-4522
(859) 734-4370
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07368
KY
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122941
PK
—
05
—
4590576700
—
KY
05
—
54024773
—
KY
05
—
7100089810
—
KY
Enumeration date
10/02/2006
Last updated
05/23/2016
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