Woodburn Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PO6539 Issued in KY

Legal business name

WOODBURN PHARMACY, LLC

Practice address

400 E Arcadia Ave
Dawson Springs, KY 42408-1638

Phone

(270) 797-2761

Fax

(270) 797-3473

NPI assigned

Oct 3, 2006

Last updated

Feb 8, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael L Keller, PHARMD, RPHNPI 1730275892

Title

Member

Phone

(270) 797-2010

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael L Keller, R.PH., PHARM.D.

  • Pharmacist
  • Salem, KY
  • NPI 1730275892
  NPD Authorized official
• Tyler Guess, PHARMD

  • Ambulatory Care Pharmacist
  • Dawson Springs, KY
  • NPI 1194340703
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486512000000",
    "number": "1063507648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E ARCADIA AVE",
            "city": "DAWSON SPRINGS",
            "state": "KY",
            "postal_code": "424081638",
            "telephone_number": "270-797-2761",
            "fax_number": "270-797-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E ARCADIA AVE",
            "city": "DAWSON SPRINGS",
            "state": "KY",
            "postal_code": "424081638",
            "telephone_number": "270-797-2761",
            "fax_number": "270-797-3473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBURN PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2017-02-08",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "270-797-2010",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD, RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "KY",
            "license": "PO6539",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "PO6539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "1804411",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54000757",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90008194",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tradewater Pointe, LLC (Tradewater Pointe)
• Courtney Cathrine Trimble
• Bethany Jane Waggoner
• Mariah Willett Webb, AGNP-C
• Jeffrey Layne Winfrey, DMD
• Kayla Woodfork, PTA

• Community/Retail Pharmacy in Dawson Springs, KY
• Providers in Dawson Springs, KY by specialty
• Community/Retail Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.