Provider Demographics
NPI:1699744391
Name:NORTH PARK PHARMACY, INC
Entity type:Organization
Organization Name:NORTH PARK PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CULL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-484-3113
Mailing Address - Street 1:327 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OWENTON
Mailing Address - State:KY
Mailing Address - Zip Code:40359-1409
Mailing Address - Country:US
Mailing Address - Phone:502-484-3174
Mailing Address - Fax:502-484-0141
Practice Address - Street 1:327 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-1409
Practice Address - Country:US
Practice Address - Phone:502-484-3174
Practice Address - Fax:502-484-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90020942Medicaid
KY0668260001Medicare NSC