Healthcare Provider Details

I. General information

NPI: 1265530034
Provider Name (Legal Business Name): CENTRAL STATE HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 LAGRANGE RD
LOUISVILLE KY
40223-1277
US

IV. Provider business mailing address

10510 LAGRANGE RD
LOUISVILLE KY
40223-1277
US

V. Phone/Fax

Practice location:
  • Phone: 502-253-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberP05065
License Number StateKY

VIII. Authorized Official

Name: MS. PATRICIA P BRODIE
Title or Position: HOSPITAL DIRECTOR
Credential:
Phone: 502-253-7000