Active NPI
College Square Pharmacy
- Durable Medical Equipment & Medical Supplies
- Berea, KY
National Provider Identifier
1992790984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- P06904
- Legal business name
- COLLEGE SQUARE PHARMACY
- Practice address
- 191 Glades Rd
Berea, KY 40403 - Phone
- (859) 986-0500
- Fax
- (859) 986-0505
- NPI assigned
- Sep 15, 2005
- Organization subpart
- Yes
- Parent organization
- COLLEGE SQUARE PHARMACY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Erin E Knight
- Title
- Owner
- Phone
- (859) 986-0500
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | P06904 | KY | Primary |
| Pharmacy | 333600000X | P06904 | KY |
Addresses
Primary practice location
191 Glades Rd
Berea, KY 40403
Mailing address
PO Box 1018
Berea, KY 40403
Phone (859) 986-0500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54006085 | Medicaid | KY | |
| 90008384 | Medicaid | KY | |
| P300037221 | Other | KY | PTAN |
Other names 1
- Knights Pharmacy
National Provider Directory
National Provider Directory- Part of
- Knights Pharmacy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126742400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1300752000000",
"number": "1992790984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1018",
"city": "BEREA",
"state": "KY",
"postal_code": "40403",
"telephone_number": "859-986-0500",
"fax_number": "859-986-0505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "191 GLADES RD",
"city": "BEREA",
"state": "KY",
"postal_code": "40403",
"telephone_number": "859-986-0500",
"fax_number": "859-986-0505"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COLLEGE SQUARE PHARMACY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COLLEGE SQUARE PHARMACY",
"enumeration_date": "2005-09-15",
"last_updated": "2011-03-22",
"status": "A",
"authorized_official_last_name": "KNIGHT",
"authorized_official_first_name": "ERIN",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "859-986-0500",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "KY",
"license": "P06904",
"primary": true
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "KY",
"license": "P06904",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "54006085",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "90008384",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "P300037221",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Knights Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Berea, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.