Healthcare Provider Details

I. General information

NPI: 1306878988
Provider Name (Legal Business Name): ELY DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HAPPY VALLEY RD
GLASGOW KY
42141-1537
US

IV. Provider business mailing address

415 HAPPY VALLEY RD
GLASGOW KY
42141-1537
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-8359
  • Fax:
Mailing address:
  • Phone: 270-651-8359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number012590
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP00704
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPOO704
License Number StateKY

VIII. Authorized Official

Name: TRAVIS K. HUDNALL
Title or Position: PRESIDENT
Credential:
Phone: 270-651-5159