Provider Demographics
NPI:1306922018
Name:EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER INCORPORATED
Entity type:Organization
Organization Name:EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:VICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:589-239-1706
Mailing Address - Street 1:217 SOUTH THIRD STREET
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422
Mailing Address - Country:US
Mailing Address - Phone:859-239-1706
Mailing Address - Fax:859-239-6759
Practice Address - Street 1:217 SOUTH THIRD STREET
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-239-1706
Practice Address - Fax:859-239-6759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPNHRAIM MCDOWELL REGIONAL MEDICAL CENTER INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
KYP064913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1814474OtherNABP
KYP06491OtherPHARMACY LICENSE
KY5403145500Medicaid
BE6508622OtherDEA
KYP06491OtherPHARMACY LICENSE