MEDICARE: MEDWIZ OF KENTUCKY, 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1578104287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDWIZ OF KENTUCKY, LLC

Provider Business Mailing Address
First Line	:	116 VENTURE CT STE 4-5-6
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-2625
Country	:	US
Telephone Number	:	859-479-3990
Fax Number	:	859-479-3989

Provider Business Practice Location Address
First Line	:	116 VENTURE CT SUITES 4-5-6
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-2625
Country	:	US
Telephone Number	:	859-479-3990
Fax Number	:	859-479-3989

Authorized Official
Title or Position	:	CEO
Name	:	ARON UNGAR
Credential	:
Telephone Number	:	845-825-9089

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	05/19/2020

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