Eric Shannon Polston, PHARMD,DO
Individual provider Active NPI Pharmacist · Whitley City, KY
NPI 1912423435 · NPPES record last updated Aug 16, 2017
Key facts
- NPI
- 1912423435
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 11944 (KY)
- Practice address
- 43 Medical Lane
Whitley City, KY 42653 - Phone
- (606) 376-1535
- NPI assigned
- Aug 16, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Osteopathy, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11944 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bowynn Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11944 | KY | Yes |
Addresses
Primary practice location
43 Medical Lane
Whitley City, KY 42653
Mailing address
238 Lily Creek Resort Rd
Jamestown, KY 42629-7911
Phone (270) 343-4861
Other providers in Whitley City, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.