Provider Demographics
NPI:1972695427
Name:POOLES PHARMACY CARE INC
Entity type:Organization
Organization Name:POOLES PHARMACY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO.AO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:270-754-1545
Mailing Address - Street 1:311 HENTON ST
Mailing Address - Street 2:P.O. BOX 91
Mailing Address - City:LIVERMORE
Mailing Address - State:KY
Mailing Address - Zip Code:42352-2126
Mailing Address - Country:US
Mailing Address - Phone:270-278-5537
Mailing Address - Fax:270-278-5539
Practice Address - Street 1:311 HENTON ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:KY
Practice Address - Zip Code:42352-2126
Practice Address - Country:US
Practice Address - Phone:270-278-5537
Practice Address - Fax:270-278-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336S0011X
KYP071413336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2034628OtherPK
KY90013780Medicaid
KY54012497Medicaid
0710080003Medicare NSC