Healthcare Provider Details

I. General information

NPI: 1699319814
Provider Name (Legal Business Name): ST. MATTHEWS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N HURSTBOURNE PKWY STE 174
LOUISVILLE KY
40222-5138
US

IV. Provider business mailing address

9500 ORMSBY STATION RD STE 400
LOUISVILLE KY
40223-4076
US

V. Phone/Fax

Practice location:
  • Phone: 502-690-4462
  • Fax: 502-690-4466
Mailing address:
  • Phone: 502-690-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY ECKMANN
Title or Position: CEO
Credential:
Phone: 502-690-4462