Clover Fork Outpatient Medical Project Inc
Organization Active NPI Pharmacy · Evarts, KY
NPI 1376565226 · NPPES record last updated Oct 21, 2015
Key facts
- NPI
- 1376565226
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- P01273 (KY)
- Legal business name
- CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
- Practice address
- 101 Chad St
Evarts, KY 40828 - Phone
- (606) 837-2100
- Fax
- (606) 837-9389
- NPI assigned
- Jul 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Britt Lewis Jr.
- Title
- Administrator
- Phone
- (606) 837-2108
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | P01273 | KY | |
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | P01273 | KY | |
| Pharmacy | 333600000X | P01273 | KY | Yes |
Addresses
Primary practice location
101 Chad St
Evarts, KY 40828
Mailing address
PO Box 39
Evarts, KY 40828-0039
Phone (606) 837-2108
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54034913 | Medicaid | KY |
Other names
- Clover Fork Clinical Pharmacy
Other providers in Evarts, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.