Provider Demographics
NPI:1912523614
Name:OLDHAM PHARMACIST GROUP
Entity type:Organization
Organization Name:OLDHAM PHARMACIST GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-465-5500
Mailing Address - Street 1:1000 CHERRYWOOD PL STE 100
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8927
Mailing Address - Country:US
Mailing Address - Phone:502-465-5500
Mailing Address - Fax:502-465-5600
Practice Address - Street 1:1000 CHERRYWOOD PL STE 100
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8927
Practice Address - Country:US
Practice Address - Phone:502-465-5500
Practice Address - Fax:502-465-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100679230Medicaid