Organization
LEWIS COUNTY PRIMARY CARE CENTER, INC.
Active
Other names
Tollesboro Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD EVANS PHARMD (DIRECTOR OF PHARMACY)
(606) 956-0188
Entity
Organization
Contact information
Practice address
17521 W KY HWY 9, TOLLESBORO, KY 41189
(606) 798-2072
(606) 798-4276
Mailing address
PO BOX 220, TOLLESBORO, KY 41189-0220
(606) 798-2072
(606) 798-4276
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06782
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2034000
PK
—
05
—
54003603
—
KY
Enumeration date
08/10/2006
Last updated
04/04/2017
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