Organization
J W PHARMACY
Active
Other names
J & R Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES H WISEMAN (OWNER PRES)
(270) 527-9374
Entity
Organization
Contact information
Practice address
817 MAIN ST, BENTON, KY 42025-1240
(270) 527-9374
(270) 527-3152
Mailing address
817 MAIN ST, BENTON, KY 42025-1240
(270) 527-9374
(270) 527-3152
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
00663
KY
314000000X
Skilled Nursing Facility
00663
KY
333600000X
Pharmacy
Primary
00663
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801100
NABP
KY
05
—
54009600
—
KY
Enumeration date
08/30/2006
Last updated
10/11/2016
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