NPIMap

Organization Active NPI

Main Street Pharmacy LLC

Doing business as Main Street Pharmacy

  • Community/Retail Pharmacy
  • Mount Vernon, KY
National Provider Identifier
1669652210
Registry record updated Aug 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P07220 Issued in KY
Legal business name
MAIN STREET PHARMACY LLC
Doing business as
Main Street Pharmacy
Practice address
150 Main Street Pharmacy
Mt Vernon, KY 40456
Phone
(606) 256-0475
Fax
(606) 256-0421
NPI assigned
Nov 13, 2007
Last updated
Aug 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2011

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

Authorized official

Name
Eric GibbsNPI 1255440806
Title
Owner
Phone
(606) 258-0000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X P07220 KY Primary

Addresses

Primary practice location

150 Main Street Pharmacy
Mt Vernon, KY 40456

Mailing address

150 Main Street Pharmacy
Mt Vernon, KY 40456
Phone (606) 256-0475

Other identifiers 3

IdentifierTypeStateIssuer
7100037810MedicaidKY
1830416OtherNCPDP PROVIDER IDENTIFICATION NUMBER
7100014800MedicaidKY

Other names 1

  • MAIN STREET PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

150 Main St
Mount Vernon, KY 40456
Phone (606) 256-0475

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314230400000",
    "number": "1669652210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MAIN STREET PHARMACY",
            "city": "MT VERNON",
            "state": "KY",
            "postal_code": "40456",
            "telephone_number": "606-256-0475",
            "fax_number": "606-256-0421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MAIN STREET PHARMACY",
            "city": "MT VERNON",
            "state": "KY",
            "postal_code": "40456",
            "telephone_number": "606-256-0475",
            "fax_number": "606-256-0421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2011-08-25",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-258-0000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100037810",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1830416",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100014800",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN STREET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; 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.