Provider Demographics
NPI:1285374397
Name:CCPB
Entity type:Organization
Organization Name:CCPB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-688-3112
Mailing Address - Street 1:268 ROLLING HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633
Mailing Address - Country:US
Mailing Address - Phone:606-688-3112
Mailing Address - Fax:
Practice Address - Street 1:268 ROLLING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633
Practice Address - Country:US
Practice Address - Phone:606-688-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CCPB, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy