Provider Demographics
NPI:1487741344
Name:SRPB INC
Entity type:Organization
Organization Name:SRPB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-394-2027
Mailing Address - Street 1:3501 SHORTCUT RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:KY
Mailing Address - Zip Code:41007-8471
Mailing Address - Country:US
Mailing Address - Phone:859-448-0309
Mailing Address - Fax:859-448-0312
Practice Address - Street 1:3501 SHORTCUT RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:KY
Practice Address - Zip Code:41007-8471
Practice Address - Country:US
Practice Address - Phone:859-448-0309
Practice Address - Fax:859-448-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP071353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1829728OtherNCPDP PROVIDER IDENTIFICATION NUMBER