Healthcare Provider Details

I. General information

NPI: 1629281837
Provider Name (Legal Business Name): AMY CARLTON FEGENBUSH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S JACKSON STREET
LOUISVILLE KY
40202-1675
US

IV. Provider business mailing address

530 S JACKSON ST
LOUISVILLE KY
40202-1675
US

V. Phone/Fax

Practice location:
  • Phone: 502-562-3436
  • Fax:
Mailing address:
  • Phone: 502-562-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number011990
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: