MEDICARE: ST. MATTHEWS PHARMACY LLC

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
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1265380646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MATTHEWS PHARMACY LLC

Provider Business Mailing Address
First Line	:	9500 ORMSBY STATION RD STE 400
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4076
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 E BROADWAY # 100-P
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1037
Country	:	US
Telephone Number	:	502-406-2108
Fax Number	:	844-601-3446

Authorized Official
Title or Position	:	PHARMACY ADMINISTRATIVE SPECIALIST
Name	:	FARA TIPPIT
Credential	:
Telephone Number	:	720-272-3535

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	06/24/2026

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