Healthcare Provider Details

I. General information

NPI: 1477506202
Provider Name (Legal Business Name): FAMILY HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 PORTLAND AVE
LOUISVILLE KY
40212-1033
US

IV. Provider business mailing address

2215 PORTLAND AVE
LOUISVILLE KY
40212-1033
US

V. Phone/Fax

Practice location:
  • Phone: 502-772-0889
  • Fax: 502-775-6155
Mailing address:
  • Phone: 502-772-0889
  • Fax: 502-775-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPO1226
License Number StateKY

VIII. Authorized Official

Name: MORRIS LLOYD
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 502-772-0889