Healthcare Provider Details

I. General information

NPI: 1386057990
Provider Name (Legal Business Name): UNIVERSITY OF KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SOUTH LIMESTONE ST ROOM C-017
LEXINGTON KY
40508-3008
US

IV. Provider business mailing address

310 SOUTH LIMESTONE ST ROOM C-017
LEXINGTON KY
40508-3008
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-4777
  • Fax: 859-257-5590
Mailing address:
  • Phone: 859-218-4777
  • Fax: 859-257-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP07636
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberP07636
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07636
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberP07636
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberP07636
License Number StateKY

VIII. Authorized Official

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