Provider Demographics
NPI:1306150917
Name:POWERS PHARMACY INC
Entity type:Organization
Organization Name:POWERS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C-OOWNERPRES, AO
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-634-6580
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:9500 HWY 805
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-0747
Mailing Address - Country:US
Mailing Address - Phone:606-832-2121
Mailing Address - Fax:606-832-0046
Practice Address - Street 1:9500 HIGHWAY 805
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-8183
Practice Address - Country:US
Practice Address - Phone:606-832-2121
Practice Address - Fax:606-832-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP074113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127837OtherPK
KY7100133980Medicaid