Healthcare Provider Details

I. General information

NPI: 1164506291
Provider Name (Legal Business Name): KUPPER & DAUGHTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9843 3RD STREET RD
LOUISVILLE KY
40272-2801
US

IV. Provider business mailing address

9843 3RD STREET RD
LOUISVILLE KY
40272-2801
US

V. Phone/Fax

Practice location:
  • Phone: 502-933-8444
  • Fax: 502-933-8477
Mailing address:
  • Phone: 502-933-8444
  • Fax: 502-933-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07157
License Number StateKY

VIII. Authorized Official

Name: MICHAEL KUPPER
Title or Position: PHARMACIST IN CHARGE
Credential: BS PHARMACY
Phone: 502-933-8444