Organization
PAT'S PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH KELLY JOHNSON (PRESIDENT)
(270) 692-4950
Entity
Organization
Contact information
Practice address
498 W. MAIN ST., LEBANON, KY 40033-1362
(270) 692-4950
(270) 692-2320
Mailing address
498 W. MAIN ST., LEBANON, KY 40033-1362
(270) 692-4950
(270) 692-2320
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
007247
KY
332B00000X
Durable Medical Equipment & Medical Supplies
90006735
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
45542818
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
54019211
KY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000070377
ANTHEM BCBS
KY
01
—
45542818
MEDICAID; EPSDT PROVIDER NO.
KY
05
—
54019211
—
KY
05
—
90006735
—
KY
Enumeration date
10/02/2006
Last updated
08/16/2022
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