Healthcare Provider Details

I. General information

NPI: 1053421560
Provider Name (Legal Business Name): BRUCE D. POLLY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 QUEENDALE CTR
BEVERLY KY
40913-9608
US

IV. Provider business mailing address

3733 KENESAW DR
LEXINGTON KY
40515-1217
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-3186
  • Fax: 606-598-7788
Mailing address:
  • Phone: 859-271-0133
  • Fax: 859-257-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010109
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: