Provider Demographics
NPI:1902982846
Name:PHARMACON, LLC
Entity Type:Organization
Organization Name:PHARMACON, LLC
Other - Org Name:CARE MORE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:THORNBURY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-935-4777
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:DORTON
Mailing Address - State:KY
Mailing Address - Zip Code:41520-0370
Mailing Address - Country:US
Mailing Address - Phone:606-639-2273
Mailing Address - Fax:606-639-2216
Practice Address - Street 1:151 DORTON-JENKINS HIGHWAY
Practice Address - Street 2:
Practice Address - City:DORTON
Practice Address - State:KY
Practice Address - Zip Code:41520
Practice Address - Country:US
Practice Address - Phone:606-639-2273
Practice Address - Fax:606-639-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90350984332B00000X
1231570001332B00000X
KYP066013336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54033550Medicaid
18-25100OtherNCPDP
KY90350984Medicaid
KYP06601OtherSTATE RX LIC.
KYP06601OtherSTATE RX LIC.
18-25100OtherNCPDP