Provider Demographics
NPI:1023617917
Name:CHILDERS, JAMES (RPH,LDE)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:RPH,LDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W LOWRY LN STE 190
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3030
Mailing Address - Country:US
Mailing Address - Phone:859-276-2119
Mailing Address - Fax:859-276-2938
Practice Address - Street 1:150 W LOWRY LN STE 190
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3030
Practice Address - Country:US
Practice Address - Phone:859-276-2119
Practice Address - Fax:859-276-2938
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0110551835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist