Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake Cumberland Pharmacy LLC

Organization Parenteral & Enteral Nutrition Supplies (DME) · NPI 1912217589

Lake Cumberland Pharmacy LLC is a Parenteral & Enteral Nutrition Supplies (DME) in Russell Springs, Kentucky. Licensed in Kentucky. Registered with an NPI since 2010.

Licensed in
KY
In the registry since
2010
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2431C Lakeway Dr
Russell Springs, KY 42642-4510
Phone: (270) 858-6400
Fax: (270) 866-7542
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X · Licence P07417 (KY)
Parenteral & Enteral Nutrition Supplies (DME) Taxonomy 332BP3500X
Pharmacy Taxonomy 333600000X
Home Infusion Therapy Pharmacy Taxonomy 3336H0001X

Record details

NPI number1912217589
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jonathan Gider — Pharmacist-In-Charge · (270) 585-2221
Other names Lake Cumberland Pharmacy
NPI enumeratedOctober 18, 2010
Last updated in NPPESNovember 14, 2024
Certification dateNovember 14, 2024
Mailing addressPo Box 72, Russell Springs, KY 42642-0072

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