NPIMap

Organization Active NPI

Central City Clinic Pharmacy, Inc.

Doing business as Clinic Pharmacy Madisonville

  • Community/Retail Pharmacy
  • Madisonville, KY
National Provider Identifier
1578066072
Registry record updated Mar 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P07870 Issued in KY
Legal business name
CENTRAL CITY CLINIC PHARMACY, INC.
Doing business as
Clinic Pharmacy Madisonville
Practice address
510 Ruby Dr
Madisonville, KY 42431-2168
Phone
(270) 754-4300
Fax
(270) 754-9881
NPI assigned
Mar 12, 2018
Last updated
Mar 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2018

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

Authorized official

Name
Theresa Powers Elliott, DO
Title
Cpa
Phone
(270) 684-3414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X P07870 KY Primary

Addresses

Primary practice location

510 Ruby Dr
Madisonville, KY 42431-2168

Mailing address

203 N 2ND St
Central City, KY 42330-1205
Phone (270) 754-4300

Other identifiers 1

IdentifierTypeStateIssuer
P07870OtherKYPHARMACY PERMIT

Other names 1

  • Clinic Pharmacy Madisonville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Central City Clinic Pharmacy Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1520812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520812800000",
    "number": "1578066072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 N 2ND ST",
            "city": "CENTRAL CITY",
            "state": "KY",
            "postal_code": "423301205",
            "telephone_number": "270-754-4300",
            "fax_number": "270-754-9881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 RUBY DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424312168",
            "telephone_number": "270-754-4300",
            "fax_number": "270-754-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CITY CLINIC PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-12",
        "last_updated": "2018-03-12",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "POWERS",
        "authorized_official_title_or_position": "CPA",
        "authorized_official_telephone_number": "270-684-3414",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY PERMIT",
            "identifier": "P07870",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinic Pharmacy Madisonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madisonville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2018; 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.