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
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