Ickyma LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P06879 Issued in KY

Legal business name

ICKYMA LLC

Doing business as

Bondurant's Pharmacy

Practice address

1465 Village Dr
Lexington, KY 40504-1614

Phone

(859) 254-8852

Fax

(859) 254-8853

NPI assigned

Feb 2, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Eric Daniel Brewer

Title

Member

Phone

(859) 254-8852

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bondurant's Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1265570824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 TANBARK RD",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405151872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 VILLAGE DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405041614",
            "telephone_number": "859-254-8852",
            "fax_number": "859-254-8853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICKYMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "859-254-8852",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P06879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54005715",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bondurant's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Lexington, KY
• Providers in Lexington, 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 Mar 7, 2023; 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.