Provider Demographics
NPI:1871684068
Name:NEWPORT DRUG CENTER INC
Entity type:Organization
Organization Name:NEWPORT DRUG CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-291-2578
Mailing Address - Street 1:39 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1444
Mailing Address - Country:US
Mailing Address - Phone:859-291-2578
Mailing Address - Fax:859-655-4843
Practice Address - Street 1:39 W 10TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1444
Practice Address - Country:US
Practice Address - Phone:859-291-2578
Practice Address - Fax:859-655-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP066533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1807467OtherNCPDP
KY54010251Medicaid
KY54010251Medicaid