Organization
BLUEGRASS PHARMACIES, INC
Active
Other names
Bluegrass Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY STEPHEN RUSSELL R.PH. (PRESIDENT)
(270) 825-2775
Entity
Organization
Contact information
Practice address
1128 N MAIN ST, MADISONVILLE, KY 42431-1265
(270) 825-2775
(270) 825-0413
Mailing address
1128 N MAIN ST, MADISONVILLE, KY 42431-1265
(270) 825-2775
(270) 825-0413
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PO1392
KY
333600000X
Pharmacy
Primary
1392
KY
3336H0001X
Home Infusion Therapy Pharmacy
PO1392
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54016753
—
KY
Enumeration date
07/19/2005
Last updated
05/20/2015
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