Organization
MT. VERNON DRUG, INC.
Active
Organization
MT. VERNON DRUG, INC.
Active
Other names
Stanford Drug
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLISON STIGALL GRUBBS PHARM.D. (PHARMACIST IN CHARGE)
(606) 365-2100
Entity
Organization
Contact information
Practice address
107 METKER TRL STE D, STANFORD, KY 40484-1049
(606) 365-2100
(606) 365-4153
Mailing address
PO BOX 364, STANFORD, KY 40484-0364
(606) 365-2100
(606) 365-4153
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P06743
KY
3336C0003X
Community/Retail Pharmacy
Primary
P06743
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54003157
—
KY
05
—
90006503
—
KY
Enumeration date
09/16/2006
Last updated
03/07/2023
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