Organization
CENTRAL CITY CLINIC PHARMACY INC
Active
Organization
CENTRAL CITY CLINIC PHARMACY INC
Active
Other names
Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE FOGLE RPH (PIC)
(270) 754-4300
Entity
Organization
Contact information
Practice address
203 N 2ND ST, CENTRAL CITY, KY 42330-1205
(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
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P00339
KY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2028602
PK
—
05
—
54012455
—
KY
Enumeration date
10/09/2006
Last updated
05/16/2020
Update your record
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