Provider Demographics
NPI:1992747455
Name:CRESTVILLE DRUGS INC
Entity type:Organization
Organization Name:CRESTVILLE DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHICKLING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:859-341-1666
Mailing Address - Street 1:1980 N BEND RD
Mailing Address - Street 2:STE C
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-9123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1980 N BEND RD
Practice Address - Street 2:STE C
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-9123
Practice Address - Country:US
Practice Address - Phone:859-689-9084
Practice Address - Fax:859-689-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO7056333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1829146OtherOTHER ID NUMBER-COMMERCIAL NUMBER
KY54011119Medicaid
1829146OtherOTHER ID NUMBER-COMMERCIAL NUMBER