Provider Demographics
NPI:1902908916
Name:MICHAEL F DURBIN
Entity Type:Organization
Organization Name:MICHAEL F DURBIN
Other - Org Name:CAMPBELLS DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-287-7191
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-0305
Mailing Address - Country:US
Mailing Address - Phone:606-287-7192
Mailing Address - Fax:606-287-3760
Practice Address - Street 1:100 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCKEE
Practice Address - State:KY
Practice Address - Zip Code:40447-0305
Practice Address - Country:US
Practice Address - Phone:606-287-7191
Practice Address - Fax:606-287-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP018163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1807126OtherOTHER ID NUMBER
KY54002803Medicaid
KY90020553OtherMEDICAID DME
1807126OtherOTHER ID NUMBER