Provider Demographics
NPI:1861413221
Name:POOLE'S' PHARMACY CARE, INC.
Entity type:Organization
Organization Name:POOLE'S' PHARMACY CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-486-1534
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:KY
Mailing Address - Zip Code:42352-0091
Mailing Address - Country:US
Mailing Address - Phone:270-278-2367
Mailing Address - Fax:270-278-2368
Practice Address - Street 1:4333 SPRINGHILL DR STE 101
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4661
Practice Address - Country:US
Practice Address - Phone:270-926-6260
Practice Address - Fax:270-926-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
KYP068223336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90005752Medicaid
KY54004247Medicaid
2034014OtherPK
KY54004247Medicaid