Provider Demographics
NPI:1922832195
Name:EASTRIDGE-PHELPS PHARMACY LLC
Entity type:Organization
Organization Name:EASTRIDGE-PHELPS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-299-2333
Mailing Address - Street 1:460 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-1402
Mailing Address - Country:US
Mailing Address - Phone:270-299-2333
Mailing Address - Fax:270-299-2334
Practice Address - Street 1:460 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1402
Practice Address - Country:US
Practice Address - Phone:270-299-2333
Practice Address - Fax:270-299-2334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTRIDGE-PHELPS PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy