Provider Demographics
NPI:1154479160
Name:DOWNTOWN DRUG INC
Entity type:Organization
Organization Name:DOWNTOWN DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:606-285-0786
Mailing Address - Street 1:90 TRIANGLE STREET
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-1369
Mailing Address - Country:US
Mailing Address - Phone:606-285-0786
Mailing Address - Fax:606-285-0646
Practice Address - Street 1:90 TRIANGLE STREET
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-1369
Practice Address - Country:US
Practice Address - Phone:606-285-0786
Practice Address - Fax:606-285-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO62433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6243OtherKY PHARMACY PERMIT
KY54031612Medicaid
KY1824336OtherNCPDP