| Organization Name: | CENTRAL CITY CLINIC PHARMACY INC |
| NPI Number: | 1679660823 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANE FOGLE (PIC) |
| Mailing Address: | 203 N 2nd St Central City |
| State: | KY US |
| Postal Code: | 423301205 |
| Phone Number: | 2707544300 |
| Fax Number: | 2707549881 |
| NPI Enumeration Date: | 10/09/2006 |
| NPI Last Update Date: | 04/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Clinic Pharmacy |
| Taxonomy Definition: | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |