Provider Demographics
NPI:1972536159
Name:FOUNTAIN COURT PHARMACY
Entity type:Organization
Organization Name:FOUNTAIN COURT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-264-0337
Mailing Address - Street 1:230 FOUNTAIN CT
Mailing Address - Street 2:STE 180
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1888
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 FOUNTAIN CT
Practice Address - Street 2:STE 180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1888
Practice Address - Country:US
Practice Address - Phone:859-264-0337
Practice Address - Fax:859-264-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP071083336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1829502OtherOTHER ID NUMBER-COMMERCIAL NUMBER