Basic Information
Provider Information | |||||||||
NPI: | 1134629207 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | STERLING HEALTH SOLUTIONS INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | STERLING HEALTH PHARMACY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 236 W MAIN ST | ||||||||
Address2: |   | ||||||||
City: | MOUNT STERLING | ||||||||
State: | KY | ||||||||
PostalCode: | 403531348 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8594047686 | ||||||||
FaxNumber: | 8592744312 | ||||||||
Practice Location | |||||||||
Address1: | 209 N MAYSVILLE ST STE 200 | ||||||||
Address2: |   | ||||||||
City: | MOUNT STERLING | ||||||||
State: | KY | ||||||||
PostalCode: | 40353 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8594047686 | ||||||||
FaxNumber: | 8594986800 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/15/2018 | ||||||||
LastUpdateDate: | 06/26/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CONRAD | ||||||||
AuthorizedOfficialFirstName: | ALEX | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO/EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 8594047686 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | P07940 | KY | Y |   | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
ID | Type | State | Issuer | Description | 7100517960 | 05 | KY |   | MEDICAID |