East Main Street Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P07502 Issued in KY

Legal business name

EAST MAIN STREET PHARMACY

Practice address

279 E Main St
Hazard, KY 41701-1920

Phone

(606) 487-0107

Fax

(606) 487-0104

NPI assigned

Mar 15, 2012

Organization subpart

No

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

Authorized official

Name

Dachea Wooton, RPH

Title

Owner,Pic,Ao

Phone

(606) 487-0107

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• East Main Pharmacy LLC Doing business as

Locations

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

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442448000000",
    "number": "1174898746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2069",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417022069",
            "telephone_number": "606-487-0107",
            "fax_number": "606-487-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 E MAIN ST",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417011920",
            "telephone_number": "606-487-0107",
            "fax_number": "606-487-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MAIN STREET PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-15",
        "last_updated": "2015-09-17",
        "status": "A",
        "authorized_official_last_name": "WOOTON",
        "authorized_official_first_name": "DACHEA",
        "authorized_official_title_or_position": "OWNER,PIC,AO",
        "authorized_official_telephone_number": "606-487-0107",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07502",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100206580",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2134045",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Main Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Hazard, KY
• Providers in Hazard, 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 Sep 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.