Provider Demographics
NPI:1386742351
Name:EMORY CENTRE PHARMACY
Entity type:Organization
Organization Name:EMORY CENTRE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-684-0649
Mailing Address - Street 1:527 EMORY DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6186
Mailing Address - Country:US
Mailing Address - Phone:270-684-0649
Mailing Address - Fax:270-684-0132
Practice Address - Street 1:527 EMORY DR
Practice Address - Street 2:SUITE 7
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6186
Practice Address - Country:US
Practice Address - Phone:270-684-0649
Practice Address - Fax:270-684-0132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP02029333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54022231Medicaid
1818066OtherNABP
KY9012801Medicaid
KY54022231Medicaid