Provider Demographics
NPI:1730325127
Name:MEDICINE ARTS PHARMACY LLC
Entity type:Organization
Organization Name:MEDICINE ARTS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-843-3202
Mailing Address - Street 1:818 US 31W BYP
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2314
Mailing Address - Country:US
Mailing Address - Phone:270-843-3202
Mailing Address - Fax:270-782-8181
Practice Address - Street 1:818 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2314
Practice Address - Country:US
Practice Address - Phone:270-843-3202
Practice Address - Fax:270-782-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 332B00000X, 3336S0011X
KYP073153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100068740Medicaid
2118500OtherPK
2118500OtherPK