Healthcare Provider Details

I. General information

NPI: 1194149682
Provider Name (Legal Business Name): OWENSBORO HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLEASANT VALLEY RD SUITE 104
OWENSBORO KY
42303-9774
US

IV. Provider business mailing address

1301 PLEASANT VALLEY RD SUITE 104
OWENSBORO KY
42303-9774
US

V. Phone/Fax

Practice location:
  • Phone: 270-417-6701
  • Fax: 270-417-6705
Mailing address:
  • Phone: 270-417-6701
  • Fax: 270-417-6705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07614
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RUSS RANALLO
Title or Position: VICE PRESIDENT OF FINANCIAL SERVICE
Credential:
Phone: 270-685-7180