Basic Information
| Provider Information | |||||||||
| NPI: | 1790920783 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICA'S ASSISTED LIVING PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3524 PARK PLAZA RD | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420018900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704424579 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3524 PARK PLAZA RD | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420018900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2704424579 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2008 | ||||||||
| LastUpdateDate: | 10/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | ORMES | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2704424579 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | P07316 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | 333600000X | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | FA1227190 | 01 | KY | DEA | OTHER | 7100060060 | 05 | KY | MEDICAID | 1831002 | 01 | KY | NCPDP | OTHER | P07316 | 01 | KY | STATE | OTHER |