| Organization Name: | THREE FORKS APOTHECARY, LLC |
| NPI Number: | 1184797631 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN COLBERT (SR DIRECTOR, PAYER RELATIONS) |
| Mailing Address: | 1071 Highway 11 N Beattyville |
| State: | KY US |
| Postal Code: | 41311 |
| Phone Number: | 6064640941 |
| Fax Number: | 6064640245 |
| NPI Enumeration Date: | 11/15/2006 |
| NPI Last Update Date: | 11/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BP3500X |
| License Number: | P06251 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Parenteral & Enteral Nutrition |
| Taxonomy Definition: | |