Provider Demographics
NPI:1386891554
Name:DONELLS PHARMACY INC
Entity type:Organization
Organization Name:DONELLS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSROE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:606-573-2604
Mailing Address - Street 1:26 WOODLAND HLS
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2562
Mailing Address - Country:US
Mailing Address - Phone:606-573-4550
Mailing Address - Fax:606-575-4402
Practice Address - Street 1:26 WOODLAND HLS
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2562
Practice Address - Country:US
Practice Address - Phone:606-573-4550
Practice Address - Fax:606-575-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP072803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100051570Medicaid
1830822OtherNCPDP PROVIDER IDENTIFICATION NUMBER