Provider Demographics
NPI:1073139531
Name:EXPRESS CARE PHARMACY AND MORE
Entity type:Organization
Organization Name:EXPRESS CARE PHARMACY AND MORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-255-3154
Mailing Address - Street 1:8010 LAKE BONITA RD
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-9717
Mailing Address - Country:US
Mailing Address - Phone:502-209-9351
Mailing Address - Fax:502-780-5896
Practice Address - Street 1:1021 N LIMESTONE STE 121
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3583
Practice Address - Country:US
Practice Address - Phone:859-440-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-21
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP08191OtherBOP
SC7Z1139Medicaid