Provider Demographics
NPI:1124089180
Name:P I C CORPORATION
Entity type:Organization
Organization Name:P I C CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-674-6979
Mailing Address - Street 1:PO BOX 1119
Mailing Address - Street 2:60 SLATE AVE.
Mailing Address - City:OWINGSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40360-1119
Mailing Address - Country:US
Mailing Address - Phone:606-674-6979
Mailing Address - Fax:606-674-2637
Practice Address - Street 1:60 SLATE AVE
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-2201
Practice Address - Country:US
Practice Address - Phone:606-674-6979
Practice Address - Fax:606-674-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 332B00000X
KYP018973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2030600OtherPK
KY54020656Medicaid
KY54020656Medicaid