Organization
CENTRAL CITY CLINIC PHARMACY, INC.
Active
Organization
CENTRAL CITY CLINIC PHARMACY, INC.
Active
Other names
Clinic Pharmacy Madisonville
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA POWERS ELLIOTT DO (CPA)
(270) 684-3414
Entity
Organization
Contact information
Practice address
510 RUBY DR, MADISONVILLE, KY 42431-2168
(270) 754-4300
(270) 754-9881
Mailing address
203 N 2ND ST, CENTRAL CITY, KY 42330-1205
(270) 754-4300
(270) 754-9881
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P07870
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P07870
PHARMACY PERMIT
KY
Enumeration date
03/12/2018
Last updated
03/12/2018
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