Healthcare Provider Details

I. General information

NPI: 1316960453
Provider Name (Legal Business Name): APOTHECARE PHARMACY OF ELIZABETHTOWN PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 WOODLAND DR STE 102
ELIZABETHTOWN KY
42701-2770
US

IV. Provider business mailing address

1239 WOODLAND DR STE 102
ELIZABETHTOWN KY
42701-2770
US

V. Phone/Fax

Practice location:
  • Phone: 270-739-0303
  • Fax: 270-234-0101
Mailing address:
  • Phone: 270-739-0303
  • Fax: 270-234-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP06320
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06320
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARTIN GRAVIL
Title or Position: PHARMACIST
Credential: PHARM D
Phone: 270-739-0303