| C D S 10 Pharmacy Llc | |
|
1308 Ashley Circle Bowling Green KY 42104 | |
| (270) 779-0599 | |
| (270) 781-5652 |
| Full Name | C D S 10 Pharmacy Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1308 Ashley Circle, Bowling Green, Kentucky |
| Authorized Official Name and Position | Jane Ellen Lacefield (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2707815661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C D S 10 Pharmacy Llc 1308 Ashley Circle Bowling Green KY 42104 Ph: (270) 779-0599 | C D S 10 Pharmacy Llc 1308 Ashley Circle Bowling Green KY 42104 Ph: (270) 779-0599 |
| NPI Number | 1871255430 |
|---|---|
| Provider Enumeration Date | 10/12/2021 |
| Last Update Date | 10/12/2021 |
| Medicare PECOS PAC ID | 6901977537 |
|---|---|
| Medicare Enrollment ID | O20220224002358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871255430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Laura Purdy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093058463 PECOS PAC ID: 9133556624 Enrollment ID: I20200728001834 |
| Provider Name | Joel Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194783472 PECOS PAC ID: 7517943327 Enrollment ID: I20221222001175 |
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