Organization
BROADWAY CLINIC PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LEMASTER (MANAGER)
(606) 789-9988
Entity
Organization
Contact information
Practice address
607 S MAYO TRL, PAINTSVILLE, KY 41240
(606) 789-9988
(606) 789-7619
Mailing address
607 S MAYO TRL, PAINTSVILLE, KY 41240-1250
(606) 789-9988
(606) 789-7619
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07841
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2031830
PK
—
05
—
54008610
—
KY
Enumeration date
08/18/2006
Last updated
11/07/2022
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