Central City Clinic Pharmacy, Inc.
Organization Active NPI Community/Retail Pharmacy · Beechmont, KY
NPI 1063553345 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1063553345
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- CENTRAL CITY CLINIC PHARMACY, INC.
- Practice address
- 3901 US Hwy 41 S
Beechmont, KY 42323 - Phone
- (270) 476-3600
- Fax
- (270) 476-3100
- NPI assigned
- Feb 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Raymond Darrel Gentry, D.O.
- Title
- Pharmacist
- Phone
- (270) 476-3600
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101113000003 | KY | Part B Supplier - Mass Immunization (Roster Biller Only) | 3274650106 |
1 other NPI on this enrollment Practice locations: Beechmont, KY; Central City, KY |
National Provider Directory
- Tax ID family
- Central City Clinic Pharmacy Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
3901 US Hwy 41 S
Beechmont, KY 42323
Mailing address
3901 U.S. Hwy 41 S.
Beechmont, KY 42323
Phone (270) 476-3600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1824475 | Other | KY | NABP # |
| 54032167 | Medicaid | KY |
Other providers in Beechmont, KY
All providers in Beechmont, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.