Healthcare Provider Details

I. General information

NPI: 1568574416
Provider Name (Legal Business Name): ELY HOME INFUSION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 PERIMETER DR STE 105
LEXINGTON KY
40517-4125
US

IV. Provider business mailing address

620 PERIMETER DR STE 105
LEXINGTON KY
40517-4125
US

V. Phone/Fax

Practice location:
  • Phone: 859-268-0080
  • Fax: 859-268-0083
Mailing address:
  • Phone: 859-268-0080
  • Fax: 859-268-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberP07503
License Number StateKY

VIII. Authorized Official

Name: TRAVIS HUDNALL
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 270-651-5159