Healthcare Provider Details

I. General information

NPI: 1255095444
Provider Name (Legal Business Name): NELDA ANN EADS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E BROADWAY ST
CAMPBELLSVILLE KY
42718-2003
US

IV. Provider business mailing address

325 E BROADWAY ST
CAMPBELLSVILLE KY
42718-2003
US

V. Phone/Fax

Practice location:
  • Phone: 270-789-4663
  • Fax: 270-789-4664
Mailing address:
  • Phone: 270-789-4663
  • Fax: 270-789-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number012504
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: