Provider Demographics
NPI:1194734053
Name:PHARMACY 20, INC.
Entity type:Organization
Organization Name:PHARMACY 20, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-772-0202
Mailing Address - Street 1:82 SPRUCE STREET BUSINESS CENTER
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071
Mailing Address - Country:US
Mailing Address - Phone:270-767-1520
Mailing Address - Fax:866-233-9220
Practice Address - Street 1:82 SPRUCE STREET BUSINESS CENTER
Practice Address - Street 2:SUITE 120
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-767-1520
Practice Address - Fax:866-233-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06829333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4177370001Medicare ID - Type Unspecified