Basic Information
| Provider Information | |||||||||
| NPI: | 1598335663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEADE | ||||||||
| FirstName: | BRETTON | ||||||||
| MiddleName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 FARMVIEW WAY | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403247119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063679333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1210 KY HIGHWAY 36 E UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | CYNTHIANA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410317498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592342300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2021 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 018875 | KY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.