Individual
DERONDA KAY BACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
842 HWY 15 N, JACKSON, KY 41339
(606) 666-7060
(606) 666-9454
Mailing address
PO BOX 931, JACKSON, KY 41339-0931
(606) 666-7060
(606) 666-9454
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
008355
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008355
KY STATE LICENSE
KY
Enumeration date
05/07/2007
Last updated
07/08/2007
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