{"npi":"1679660823","type":"NPI-2","status":"active","name":{"display":"Central City Clinic Pharmacy INC","other":[],"organization_name":"CENTRAL CITY CLINIC PHARMACY INC","authorised_official":"Shane Fogle"},"specialty":{"primary_taxonomy":"3336C0003X","primary_taxonomy_description":"Community/Retail Pharmacy","slug":"community-retail-pharmacy","schema_org_specialty":null,"all":[{"code":"3336C0002X","description":"Clinic Pharmacy","primary":false,"state":null,"license":null},{"code":"3336C0004X","description":"Compounding Pharmacy","primary":false,"state":null,"license":null},{"code":"332B00000X","description":"Durable Medical Equipment & Medical Supplies","primary":false,"state":null,"license":null},{"code":"333600000X","description":"Pharmacy","primary":false,"state":null,"license":null},{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":true,"state":"KY","license":"P00339"}]},"addresses":[{"purpose":"LOCATION","street_1":"203 N 2ND ST","city":"CENTRAL CITY","state":"KY","postal_code":"423301205","country_code":"US","phone":"2707544300","fax":"2707549881"},{"purpose":"MAILING","street_1":"203 N 2ND ST","city":"CENTRAL CITY","state":"KY","postal_code":"423301205","country_code":"US","phone":"2707544300","fax":"2707549881"}],"license":{"state":"KY","number":"P00339"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"54012455","state":"KY","issuer":null},{"type_code":"01","label":"Other","value":"2028602","state":null,"issuer":"PK"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20100930051434","type_code":"30-A5","type_desc":"DME SUPPLIER - PHARMACY","state":"KY","pac_id":"3274650106"},{"enrlmt_id":"O20211006002498","type_code":"12-69","type_desc":"PART B SUPPLIER - INDEPENDENT CLINICAL LABORATORY","state":"KY","pac_id":"3274650106"}]},"enumeration_date":"2006-10-09","last_updated":"2020-05-16","_meta":{"source":"NPPES","snapshot_date":"2020-05-16","doc_url":"https://findmynpi.com/api"}}