Organization
MAIN STREET PHARMACY LLC
Active
Organization
MAIN STREET PHARMACY LLC
Active
Other names
MAIN STREET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GIBBS (OWNER)
(606) 258-0000
Entity
Organization
Contact information
Practice address
150 MAIN STREET PHARMACY, MT VERNON, KY 40456
(606) 256-0475
(606) 256-0421
Mailing address
150 MAIN STREET PHARMACY, MT VERNON, KY 40456
(606) 256-0475
(606) 256-0421
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07220
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1830416
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
7100014800
—
KY
05
—
7100037810
—
KY
Enumeration date
11/13/2007
Last updated
08/25/2011
Update your record
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