Organization
MED EXPRESS PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMARA BENTLEY MAYNARD (OWNER/PHARMACIST)
(606) 789-4410
Entity
Organization
Contact information
Practice address
212 S MAYO TRL, PAINTSVILLE, KY 41240-1330
(606) 789-1444
(606) 789-4887
Mailing address
212 S MAYO TRL, PAINTSVILLE, KY 41240-1330
(606) 789-1444
(606) 789-4887
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P07059
KY
3336C0003X
Community/Retail Pharmacy
Primary
P07059
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1829184
NCPDP
KY
01
—
213617
STATE TAX ID#
KY
05
—
54010632
—
KY
01
—
P07059
STATE LICENSE #
KY
Enumeration date
08/13/2006
Last updated
03/07/2023
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