Provider Demographics
NPI:1568474625
Name:MED EXPRESS PHARMACY LLC
Entity type:Organization
Organization Name:MED EXPRESS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:BENTLEY
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-789-4410
Mailing Address - Street 1:212 S MAYO TRL
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1330
Mailing Address - Country:US
Mailing Address - Phone:606-789-1444
Mailing Address - Fax:606-789-4887
Practice Address - Street 1:212 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1330
Practice Address - Country:US
Practice Address - Phone:606-789-1444
Practice Address - Fax:606-789-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07059332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY213617OtherSTATE TAX ID#
KY1829184OtherNCPDP
KY54010632Medicaid
KYP07059OtherSTATE LICENSE #
KYP07059OtherSTATE LICENSE #
KY213617OtherSTATE TAX ID#