Healthcare Provider Details

I. General information

NPI: 1184504094
Provider Name (Legal Business Name): BLUEGRASS PHARMA SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 US HIGHWAY 68 E UNIT E
BENTON KY
42025-8336
US

IV. Provider business mailing address

PO BOX 766
BENTON KY
42025-0766
US

V. Phone/Fax

Practice location:
  • Phone: 270-387-1474
  • Fax:
Mailing address:
  • Phone: 270-387-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREW BROWN
Title or Position: PRESIDENT
Credential:
Phone: 270-387-1474