Provider Demographics
NPI:1386714715
Name:STALLARDS PHARMACY INC
Entity type:Organization
Organization Name:STALLARDS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:STALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-855-4428
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:NEON
Mailing Address - State:KY
Mailing Address - Zip Code:41840
Mailing Address - Country:US
Mailing Address - Phone:606-855-4428
Mailing Address - Fax:606-855-4309
Practice Address - Street 1:972 HWY 317
Practice Address - Street 2:
Practice Address - City:NEON
Practice Address - State:KY
Practice Address - Zip Code:41840
Practice Address - Country:US
Practice Address - Phone:606-855-4428
Practice Address - Fax:606-855-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0456332B00000X
KYPO68593336C0003X
KYP068593336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54005087Medicaid
KY90006990OtherMEDICAID DME
4797140001Medicare ID - Type Unspecified