Healthcare Provider Details

I. General information

NPI: 1467593517
Provider Name (Legal Business Name): DROSERA INC HUME PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10216 TAYLORSVILLE RD
JEFFERSONTOWN KY
40299-3616
US

IV. Provider business mailing address

10216 TAYLORSVILLE RD
JEFFERSONTOWN KY
40299-3616
US

V. Phone/Fax

Practice location:
  • Phone: 502-267-7453
  • Fax: 502-267-7455
Mailing address:
  • Phone: 502-267-7453
  • Fax: 502-267-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP02191
License Number StateKY

VIII. Authorized Official

Name: MR. MICHAEL SHEETS
Title or Position: VICE-PRESIDENT
Credential: RPH
Phone: 502-267-7453