Provider Demographics
NPI:1124176888
Name:CHEROKEE DRUG SHOPPE
Entity type:Organization
Organization Name:CHEROKEE DRUG SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBSER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-356-3121
Mailing Address - Street 1:6439 TAYLOR MILL RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-9343
Mailing Address - Country:US
Mailing Address - Phone:859-356-3121
Mailing Address - Fax:859-356-0656
Practice Address - Street 1:6439 TAYLOR MILL RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-9343
Practice Address - Country:US
Practice Address - Phone:859-356-3121
Practice Address - Fax:859-356-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54009154Medicaid
KYK118061Medicare UPIN