Healthcare Provider Details

I. General information

NPI: 1093713463
Provider Name (Legal Business Name): ELY DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HAPPY VALLEY ROAD
GLASGOW KY
42141
US

IV. Provider business mailing address

P.O. BOX 1778
GLASGOW KY
42141-1778
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-8359
  • Fax: 270-651-5741
Mailing address:
  • Phone: 270-651-8359
  • Fax: 270-651-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberP07216
License Number StateKY

VIII. Authorized Official

Name: MR. TRAVIS KYLE HUDNALL
Title or Position: OWNER/PRESIDENT
Credential: PH.D. BCPS
Phone: 270-651-8359