Healthcare Provider Details

I. General information

NPI: 1831540368
Provider Name (Legal Business Name): CORDANT PHARMACY KENTUCKY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 TIMBERWOOD CIR STE 202
LOUISVILLE KY
40223-5395
US

IV. Provider business mailing address

12015 E 46TH AVE SUITE 220
DENVER CO
80239-3116
US

V. Phone/Fax

Practice location:
  • Phone: 502-272-4339
  • Fax: 502-890-3874
Mailing address:
  • Phone: 855-895-8090
  • Fax: 303-371-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07796
License Number StateKY

VIII. Authorized Official

Name: BRADLEY ECKMANN
Title or Position: CHIEF OF STAFF
Credential:
Phone: 502-314-0146