Provider Demographics
NPI:1871618975
Name:SUTTON DRUGS OF LA CENTER INC
Entity type:Organization
Organization Name:SUTTON DRUGS OF LA CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:RENFROW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-665-5192
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:KY
Mailing Address - Zip Code:42056-0179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 BROADWAY
Practice Address - Street 2:
Practice Address - City:LACENTER
Practice Address - State:KY
Practice Address - Zip Code:42056
Practice Address - Country:US
Practice Address - Phone:270-665-5192
Practice Address - Fax:270-665-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 333600000X
KYP010693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029228OtherPK
KY54014162Medicaid
KY54014162Medicaid
1809536OtherNCPDP PROVIDER IDENTIFICATION NUMBER