Blacklog Apothecary Inc
Organization Active NPI Community/Retail Pharmacy · Inez, KY
NPI 1831235480 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1831235480
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- BLACKLOG APOTHECARY INC
- Practice address
- 62 Kirk PLZ
Inez, KY 41224-6501 - Phone
- (606) 298-7774
- Fax
- (606) 298-4975
- NPI assigned
- Jan 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Randall Berry Chaffin, RPH
- Title
- Owner Pharmacist
- Phone
- (606) 298-7774
Practitioners 1
-
Donald L Chaffin Jr., M.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Blacklog Apothecary Inc |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|C… | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930048946 | KY | DME Supplier - Pharmacy |
5193845766 | Practice locations: Inez, KY |
National Provider Directory
Locations
62 Kirk Plz
Inez, KY 41224
Phone (606) 298-7774
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | P01894 | KY | |
| Pharmacy | 333600000X | P01894 | KY | |
| Community/Retail Pharmacy | 3336C0003X | Yes | ||
| Compounding Pharmacy | 3336C0004X | P01894 | KY |
Addresses
Primary practice location
62 Kirk PLZ
Inez, KY 41224-6501
Mailing address
62 Kirk PLZ
Inez, KY 41224-6501
Phone (606) 298-7774
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54020623 | Medicaid | KY | |
| 1817230 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 9008080500 | Medicaid | KY |
Other names
- MEDICINE SHOPPE
Other providers in Inez, KY
- Big Sandy Health Care Inc
- Big Sandy Health Care, Inc
- Big Sandy Health Care, Inc
- Big Sandy Health Care, Inc
- Big Sandy Health Care, Inc
- Ashley Blair
- Bombshell Aesthetics & Weight Loss Clinic PLLC
- Donald L Chaffin Jr.
- Peggy S Collins
- Community Alternatives Kentucky
All providers in Inez, 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 7, 2023. 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.