Cedar Trace Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P06850 Issued in KY

Legal business name

CEDAR TRACE PHARMACY, INC.

Practice address

95 Weddington Branch Rd
Pikeville, KY 41501-3203

Phone

(606) 432-2424

Fax

(606) 432-2454

NPI assigned

Sep 25, 2006

Organization subpart

No

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

Authorized official

Name

Larry Fortenberry, RPHNPI 1861468472

Title

Co-Owner

Phone

(606) 432-2424

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larry T Fortenberry, RPH

  • Pharmacist
  • Pikeville, KY
  • NPI 1861468472
  NPD (past) Authorized official

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202688000000",
    "number": "1952402992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 WEDDINGTON BRANCH RD",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013203",
            "telephone_number": "606-432-2424",
            "fax_number": "606-432-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 WEDDINGTON BRANCH RD",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415013203",
            "telephone_number": "606-432-2424",
            "fax_number": "606-432-2454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR TRACE PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2008-02-11",
        "status": "A",
        "authorized_official_last_name": "FORTENBERRY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "606-432-2424",
        "authorized_official_credential": "RPH"
    },
    "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": "P06850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54004486",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Daxon Caudill
• Alysia L. B. Caughron, CRNA
• Whitney Marie Causey
• James Kendall Cecil, O.D.
• Cedar Creek Assisted Living
• Center for TMJ and Orofacial Disorders, PLLC
• Central Kentucky Comprehensive Imaging and Diagnostic Services LLC
• Oleandro Antonio Cercio Roa, MD
• Stacy Michelle Chaffins
• Champion Supports & Community Services, Inc

• Community/Retail Pharmacy in Pikeville, KY
• Providers in Pikeville, 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 Feb 11, 2008; 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.