Healthcare Provider Details

I. General information

NPI: 1881274637
Provider Name (Legal Business Name): LEVISA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N LEVISA RD
MOUTHCARD KY
41548-8116
US

IV. Provider business mailing address

137 N LEVISA RD
MOUTHCARD KY
41548-8116
US

V. Phone/Fax

Practice location:
  • Phone: 606-835-4991
  • Fax:
Mailing address:
  • Phone: 606-835-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH BELL
Title or Position: PRESIDENT
Credential:
Phone: 859-552-0374