Provider Demographics
NPI:1699983510
Name:RX DISCOUNT PHARMACY OF KNOX COUNTY INC
Entity type:Organization
Organization Name:RX DISCOUNT PHARMACY OF KNOX COUNTY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACT CO. ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-436-2407
Mailing Address - Street 1:P.O. BOX 1569
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702
Mailing Address - Country:US
Mailing Address - Phone:606-436-2407
Mailing Address - Fax:606-436-0727
Practice Address - Street 1:215 TREUHAFT BLVD
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906
Practice Address - Country:US
Practice Address - Phone:606-277-0577
Practice Address - Fax:606-277-0578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RX DISCOUNT PHARMACY OF KNOX COUNTY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-21
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP071733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100039200Medicaid
KY1830137OtherNCPDP
KY7100040780Medicaid
KY7100040780Medicaid
KY6088900001Medicare NSC