Healthcare Provider Details

I. General information

NPI: 1275291759
Provider Name (Legal Business Name): UNIVERSITY OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FOUNTAIN CT
LEXINGTON KY
40509-1888
US

IV. Provider business mailing address

2317 ALUMNI PARK PLZ STE 150
LEXINGTON KY
40517-4291
US

V. Phone/Fax

Practice location:
  • Phone: 833-333-8579
  • Fax: 859-257-3828
Mailing address:
  • Phone: 859-257-9521
  • Fax: 859-257-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELAINE DEBORD YOUNCE
Title or Position: CHIEF OF PAYER ADMINISTRATION
Credential:
Phone: 859-257-9521