Provider Demographics
NPI:1053428003
Name:MEDI CENTER DRUGS, INC.
Entity type:Organization
Organization Name:MEDI CENTER DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:TENHET
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-598-7933
Mailing Address - Street 1:509 MEMORIAL DR
Mailing Address - Street 2:STE 1
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6195
Mailing Address - Country:US
Mailing Address - Phone:606-598-7933
Mailing Address - Fax:606-598-1887
Practice Address - Street 1:509 MEMORIAL DR
Practice Address - Street 2:STE 1
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6195
Practice Address - Country:US
Practice Address - Phone:606-598-7933
Practice Address - Fax:606-599-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90050261332B00000X
KY1820085333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54024625Medicaid
1820085OtherNABP #
KY90050261OtherSUPPLIER #
1820085OtherNABP #
KY54024625Medicaid