Provider Demographics
NPI: | 1942398995 |
---|---|
Name: | COVERMYMEDS PHARMACY LLC |
Entity type: | Organization |
Organization Name: | COVERMYMEDS PHARMACY LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT; MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DERRICK |
Authorized Official - Middle Name: | ALAN |
Authorized Official - Last Name: | STURGILL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 513-465-4992 |
Mailing Address - Street 1: | 5101 JEFF COMMERCE DRIVE |
Mailing Address - Street 2: | SUITE A |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40219-3336 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-810-1184 |
Mailing Address - Fax: | 502-753-8393 |
Practice Address - Street 1: | 5101 JEFF COMMERCE DR STE A |
Practice Address - Street 2: | |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40219-3336 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-810-1184 |
Practice Address - Fax: | 502-753-8393 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MCKESSON DISTRIBUTION HOLDINGS LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-10-11 |
Last Update Date: | 2024-09-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 333600000X | Suppliers | Pharmacy | |
No | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
No | 3336M0002X | Suppliers | Pharmacy | Mail Order Pharmacy |
No | 3336S0011X | Suppliers | Pharmacy | Specialty Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MS | 05298 | Other | PHARMACY STATE LICENSE |
AK | 148351 | Other | PHARMACY STATE LICENSE |
NV | PH01678 | Other | PHARMACY STATE LICENSE |
KY | 7100332610 | Medicaid | |
KY | 1827104 | Other | NCPDP |
CO | OSP.0005286 | Other | PHARMACY STATE LICENSE |
FL | PH21507 | Other | PHARMACY STATE LICENSE |
GA | PHNR000170 | Other | PHARMACY STATE LICENSE |
OH | 021545800 | Other | PHARMACY STATE LICENSE |
NE | 324 | Other | PHARMACY STATE LICENSE |
PA | NP000514 | Other | PHARMACY STATE LICENSE |
NY | 036359 | Other | PHARMACY STATE LICENSE |
AL | 112709 | Other | PHARMACY STATE LICENSE |
SD | 400-2023 | Other | PHARMACY STATE LICENSE |
IA | 5110 | Other | PHARMACY STATE LICENSE |
MI | 5301008241 | Other | PHARMACY STATE LICENSE |
AR | OS01489 | Other | PHARMACY STATE LICENSE |
CT | PCN.0000417 | Other | PHARMACY STATE LICENSE |
HI | PMP-1640 | Other | PHARMACY STATE LICENSE |
NJ | 28RO00034400 | Other | PHARMACY STATE LICENSE |
IL | 054.021367 | Other | PHARMACY STATE LICENSE |
MI | 2019041864 | Other | PHARMACY STATE LICENSE |
CA | NRP2299 | Other | PHARMACY STATE LICENSE |
KY | P08325 | Other | PHARMACY PERMIT |
AZ | YOO8121 | Other | PHARMACY STATE LICENSE |
MD | P08106 | Other | PHARMACY STATE LICENSE |
CT | PCN.0000417 | Other | PHARMACY STATE LICENSE |
NV | PH01678 | Other | PHARMACY STATE LICENSE |
MT | PHA-MOP-LIC-63231 | Other | PHARMACY STATE LICENSE |
RI | PHN11708 | Other | PHARMACY STATE LICENSE |
IN | 64002846A | Other | PHARMACY STATE LICENSE |
DE | A9-0002371 | Other | PHARMACY STATE LICENSE |
PA | NP000514 | Other | PHARMACY STATE LICENSE |
NH | NR1759 | Other | PHARMACY STATE LICENSE |
AR | OS01489 | Other | PHARMACY STATE LICENSE |
KY | 1827104 | Other | NCPDP |
WI | 2031-43 | Other | PHARMACY STATE LICENSE |
SD | 400-2023 | Other | PHARMACY STATE LICENSE |
ID | 55899MS | Other | PHARMACY STATE LICENSE |
WV | MO0561421 | Other | PHARMACY STATE LICENSE |
CO | OSP.0005286 | Other | PHARMACY STATE LICENSE |
GA | PHNR000170 | Other | PHARMACY STATE LICENSE |
HI | PMP-1640 | Other | PHARMACY STATE LICENSE |
OH | 021545800 | Other | PHARMACY STATE LICENSE |
VT | 036.0134300 | Other | PHARMACY STATE LICENSE |
AL | 112709 | Other | PHARMACY STATE LICENSE |
NC | 14131 | Other | PHARMACY STATE LICENSE |
AK | 148351 | Other | PHARMACY STATE LICENSE |
TX | 32200 | Other | PHARMACY STATE LICENSE |
DC | NRX1901654 | Other | PHARMACY STATE LICENSE |