Colemans Drugstore Inc
Organization Active NPI Community/Retail Pharmacy · Stanford, KY
NPI 1386756237 · NPPES record last updated Mar 1, 2017
Key facts
- NPI
- 1386756237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- P00253 (KY)
- Legal business name
- COLEMANS DRUGSTORE INC
- Practice address
- 105 W Main St
Stanford, KY 40484-1253 - Phone
- (606) 365-2164
- Fax
- (606) 365-1181
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Alfred Pence
- Title
- President, Owner,Ao
- Phone
- (606) 365-2164
Practitioners 1
-
Crosby Grant Harris, PHARM D
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D0979197 | Colemans Drug Store Inc | Certificate of waiver | Oct 16, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Colemans Drug Store |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Orthoses: Off-The-Shelf | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930095410 | KY | DME Supplier - Pharmacy | 6901923457 | Practice locations: Stanford, KY |
| O20131126001918 | KY | Part B Supplier - Mass Immunization (Roster Biller Only) | 6901923457 | Practice locations: Stanford, KY |
National Provider Directory
Locations
105 W Main St
Stanford, KY 40484
Phone (606) 365-2164
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | P00253 | KY | Yes |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
105 W Main St
Stanford, KY 40484-1253
Mailing address
105 W Main St
Stanford, KY 40484-1253
Phone (606) 365-2164
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2029134 | Other | PK | |
| 7100237110 | Medicaid | KY |
Other names
- COLEMANS DRUG STORE
Other providers in Stanford, KY
- Haley Clark
- C. Glen Click
- Shannah Click
- Allison Goble Cocanougher
- Teresa D Coffman
- Andrew Wayne Cooper
- Alyssa Lee Ann Cornelius
- Charles Crase
- Cumberland Family Medical Center Inc
- Cumberland Family Medical Center Inc
All providers in Stanford, 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 1, 2017. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.