Healthcare Provider Details

I. General information

NPI: 1528315918
Provider Name (Legal Business Name): ELY DRUGS OF BG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4863 SCOTTSVILLE RD
BOWLING GREEN KY
42104-7909
US

IV. Provider business mailing address

4863 SCOTTSVILLE RD
BOWLING GREEN KY
42104-7909
US

V. Phone/Fax

Practice location:
  • Phone: 270-467-5225
  • Fax: 270-467-0542
Mailing address:
  • Phone: 270-467-5225
  • Fax: 270-467-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07516
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY PEDEN
Title or Position: PHARMACIST
Credential:
Phone: 270-467-5225