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Organization

MED-MART PHARMACY LLC

Active
Other names
MED-MART PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL SIZEMORE (PRESIDENT)
(606) 878-1200
Entity
Organization

Contact information

Practice address
87 C V B DR, LONDON, KY 40741-1096
(606) 878-1200
(606) 878-1214
Mailing address
87 CVB DR, LONDON, KY 40741
(606) 878-1200
(606) 878-1214

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
P07400
KY
3336C0004X
Compounding Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1831913
NCPDP PROVIDER IDENTIFICATION NUMBER
05
7100120850
KY
Enumeration date
06/15/2010
Last updated
01/10/2011
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