Provider Demographics
NPI:1144435645
Name:PHARM-MED CORPORATION
Entity type:Organization
Organization Name:PHARM-MED CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:859-421-0639
Mailing Address - Street 1:450 SOUTHLAND DR STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1831
Mailing Address - Country:US
Mailing Address - Phone:859-278-7282
Mailing Address - Fax:859-278-7299
Practice Address - Street 1:450 SOUTHLAND DR STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1831
Practice Address - Country:US
Practice Address - Phone:859-278-7282
Practice Address - Fax:859-278-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY08745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1012060001Medicare NSC