Provider Demographics
NPI:1427115583
Name:LEXINGTON COMPOUNDING PHARMACY, INC.
Entity type:Organization
Organization Name:LEXINGTON COMPOUNDING PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-276-3905
Mailing Address - Street 1:399 WALLER AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2910
Mailing Address - Country:US
Mailing Address - Phone:859-276-3905
Mailing Address - Fax:
Practice Address - Street 1:399 WALLER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2910
Practice Address - Country:US
Practice Address - Phone:859-276-3905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP069323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54016480Medicaid