Organization
BLACKLOG APOTHECARY INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL BERRY CHAFFIN RPH (OWNER PHARMACIST)
(606) 298-7774
Entity
Organization
Contact information
Practice address
62 KIRK PLZ, INEZ, KY 41224-6501
(606) 298-7774
(606) 298-4975
Mailing address
62 KIRK PLZ, INEZ, KY 41224-6501
(606) 298-7774
(606) 298-4975
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P01894
KY
333600000X
Pharmacy
P01894
KY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
P01894
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1817230
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
54020623
—
KY
05
—
9008080500
—
KY
Enumeration date
01/30/2007
Last updated
03/07/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us