Healthcare Provider Details

I. General information

NPI: 1437246626
Provider Name (Legal Business Name): PUCKETT ULLOM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 POPLAR LEVEL RD
LOUISVILLE KY
40213-1009
US

IV. Provider business mailing address

3501 POPLAR LEVEL RD
LOUISVILLE KY
40213-1009
US

V. Phone/Fax

Practice location:
  • Phone: 502-458-3229
  • Fax: 502-452-6371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPO6088
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN ULLOM
Title or Position: OWNER
Credential: RPH
Phone: 502-458-3229