Organization
LAKE CUMBERLAND PHARMACY LLC
Active
Organization
LAKE CUMBERLAND PHARMACY LLC
Active
Other names
Lake Cumberland Pharmacy #2
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN GRIDER PHARMD (MANAGING MEMBER)
(270) 858-6400
Entity
Organization
Contact information
Practice address
124 DOWELL RD, RUSSELL SPRINGS, KY 42642-4278
(270) 866-2686
(270) 866-6566
Mailing address
PO BOX 72, RUSSELL SPRINGS, KY 42642-0072
(270) 866-2686
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07440
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2128898
PK
—
05
—
7100171840
—
KY
Enumeration date
01/05/2011
Last updated
10/07/2022
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up