Organization
LYON DRUG STORE INC
Active
Other names
McConnell Health Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN NICKELL (PRESIDENT)
(270) 388-2236
Entity
Organization
Contact information
Practice address
86 CEDAR ST, KUTTAWA, KY 42055-0159
(270) 388-7371
(270) 388-5675
Mailing address
PO BOX 459, KUTTAWA, KY 42055-0459
(270) 388-7371
(270) 388-5675
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07717
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2154564
PK
—
05
—
54005699
—
KY
05
—
7100376080
—
KY
Enumeration date
01/19/2006
Last updated
01/21/2016
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