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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