Provider Demographics
NPI:1215462593
Name:ST. VINCENT DE PAUL COMMUNITY PHARMACY
Entity type:Organization
Organization Name:ST. VINCENT DE PAUL COMMUNITY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-426-7837
Mailing Address - Street 1:7033 BURLINGTON PIKE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5150
Mailing Address - Country:US
Mailing Address - Phone:859-426-7837
Mailing Address - Fax:859-426-5708
Practice Address - Street 1:7033 BURLINGTON PIKE
Practice Address - Street 2:SUITE #4
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5150
Practice Address - Country:US
Practice Address - Phone:859-426-7837
Practice Address - Fax:859-426-5708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06754251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable