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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
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