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NPI Code Detail

MEDICARE: MEDPHARMACY INC.

MEDICARE: MEDPHARMACY INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesP07688KY
23336C0004XCompounding PharmacyP07688KY
3332B00000XDurable Medical Equipment & Medical SuppliesKY
4333600000XPharmacyKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2PO7688OTHERKYKY PHARMACY

General Provider Information

NPI Number : 1174910186
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDPHARMACY INC.
Provider Business Mailing Address
First Line : 11840 COMMONWEALTH DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2309
Country : US
Telephone Number : 502-409-7324
Fax Number : 502-409-7278
Provider Business Practice Location Address
First Line : 11840 COMMONWEALTH DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2309
Country : US
Telephone Number : 502-409-7324
Fax Number : 502-409-7278
Authorized Official
Title or Position : CEO
Name : TANYA FALLER
Credential :
Telephone Number : 270-566-4429
Provider Enumeration Date : 04/17/2015
Last Update Date : 01/15/2016

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