Organization
CEDAR TRACE PHARMACY, INC.
Active
Organization
CEDAR TRACE PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY FORTENBERRY RPH (CO-OWNER)
(606) 432-2424
Entity
Organization
Contact information
Practice address
95 WEDDINGTON BRANCH RD, PIKEVILLE, KY 41501-3203
(606) 432-2424
(606) 432-2454
Mailing address
95 WEDDINGTON BRANCH RD, PIKEVILLE, KY 41501-3203
(606) 432-2424
(606) 432-2454
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06850
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54004486
—
KY
Enumeration date
09/25/2006
Last updated
02/11/2008
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