Healthcare Provider Details

I. General information

NPI: 1407643422
Provider Name (Legal Business Name): CIARA MAIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 VENTURA LN
LOUISVILLE KY
40272-3248
US

IV. Provider business mailing address

4000 KRESGE WAY
LOUISVILLE KY
40207-4605
US

V. Phone/Fax

Practice location:
  • Phone: 502-656-2865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: