Central City Clinic Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P00339 Issued in KY

Legal business name

CENTRAL CITY CLINIC PHARMACY INC

Doing business as

Clinic Pharmacy

Practice address

203 N 2ND St
Central City, KY 42330-1205

Phone

(270) 754-4300

Fax

(270) 754-9881

NPI assigned

Oct 9, 2006

Last updated

May 16, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shane Fogle, RPH

Title

Pic

Phone

(270) 754-4300

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Clinic Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in KY3 enrollments

Enrollment records 3

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Central City Clinic Pharmacy, Inc

  • Durable Medical Equipment & Medical Supplies
  • Beechmont, KY
  • NPI 1144483454

  3274650106

  Same PAC ID
• Central City Clinic Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Beechmont, KY
  • NPI 1063553345

  3274650106

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Central City Clinic Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Beechmont, KY
  • NPI 1063553345

  O20101113000003

  Same enrollment

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.

• Central City Clinic Pharmacy, Inc

  • Durable Medical Equipment & Medical Supplies
  • Beechmont, KY
  • NPI 1144483454
  NPD tax ID
• Central City Clinic Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Beechmont, KY
  • NPI 1063553345
  NPD tax ID
• Central City Clinic Pharmacy, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Central City, KY
  • NPI 1205967395
  NPD tax ID
• Central City Clinic Pharmacy, Inc.

  dba Clinic Pharmacy Madisonville

  • Community/Retail Pharmacy
  • Madisonville, KY
  • NPI 1578066072
  NPD tax ID

Locations

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.

• Ladonna J Abney

  • Pharmacist
  • Beechmont, KY
  • NPI 1215489174
  NPD (past)

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589587200000",
    "number": "1679660823",
    "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": "203 N 2ND ST",
            "city": "CENTRAL CITY",
            "state": "KY",
            "postal_code": "423301205",
            "telephone_number": "270-754-4300",
            "fax_number": "270-754-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CITY CLINIC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2020-05-16",
        "certification_date": "2020-05-16",
        "status": "A",
        "authorized_official_last_name": "FOGLE",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "270-754-4300",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P00339",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2028602",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54012455",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chaslyn Eve-Anmarie Bruner, LCSW
• C B Podiatric Services
• Brooke Michelle Cates, M.S, SLP
• Amanda S. Cecil, LCSW
• Central City Chiropractic, PLLC
• Central City Clinic Pharmacy, Inc.
• Sonja M Collins, ARNP, FNP C
• Community Oxygen & Medical Equipment, Inc
• Holly Ann Courtney, PHARMD
• Destiny Shea Crick, PTA

• Community/Retail Pharmacy in Central City, KY
• Providers in Central City, 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 May 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.