Provider Demographics
NPI:1992871768
Name:PEYTON'S PHARMACY, INC
Entity type:Organization
Organization Name:PEYTON'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-743-3163
Mailing Address - Street 1:414 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-1014
Mailing Address - Country:US
Mailing Address - Phone:606-743-3163
Mailing Address - Fax:606-743-3335
Practice Address - Street 1:414 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-1014
Practice Address - Country:US
Practice Address - Phone:606-743-3163
Practice Address - Fax:606-743-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9000556200332B00000X
KYP007523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9000556200OtherKY MEDICAID DME
KY54012026Medicaid
KY54012026Medicaid