Provider Demographics
NPI:1386609972
Name:PRATER DRUG INC
Entity type:Organization
Organization Name:PRATER DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-349-3135
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-0068
Mailing Address - Country:US
Mailing Address - Phone:606-349-3135
Mailing Address - Fax:606-349-3512
Practice Address - Street 1:49 SOUTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-0068
Practice Address - Country:US
Practice Address - Phone:606-349-3135
Practice Address - Fax:606-349-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP00834332BC3200X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54005780Medicaid
KY45543493OtherEPS-DT