Healthcare Provider Details

I. General information

NPI: 1366611832
Provider Name (Legal Business Name): UNIVERSITY OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 COWTOWN RD
HINDMAN KY
41822
US

IV. Provider business mailing address

59 COWTOWN ROAD
HINDMAN KY
41822
US

V. Phone/Fax

Practice location:
  • Phone: 606-785-3175
  • Fax: 606-435-0564
Mailing address:
  • Phone: 606-785-3178
  • Fax: 606-785-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number07242
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07242
License Number StateKY

VIII. Authorized Official

Name: DR. JOE EAGLE KINGERY
Title or Position: CEO
Credential: D.O.
Phone: 606-439-1559