Healthcare Provider Details

I. General information

NPI: 1134448863
Provider Name (Legal Business Name): GLASS ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAIN ST
MIDWAY KY
40347-5024
US

IV. Provider business mailing address

PO BOX 4344
MIDWAY KY
40347-4344
US

V. Phone/Fax

Practice location:
  • Phone: 859-846-4146
  • Fax: 859-846-4148
Mailing address:
  • Phone: 859-846-9640
  • Fax: 859-846-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07399
License Number StateKY

VIII. Authorized Official

Name: KENNETH GLASS
Title or Position: OWNER/LLC MEMBER
Credential:
Phone: 502-619-0815