Healthcare Provider Details

I. General information

NPI: 1609208396
Provider Name (Legal Business Name): CPHARMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 HIGHWAY 127 N
OWENTON KY
40359-9302
US

IV. Provider business mailing address

965 HIGHWAY 127 N
OWENTON KY
40359-9302
US

V. Phone/Fax

Practice location:
  • Phone: 502-484-3046
  • Fax: 502-484-1032
Mailing address:
  • Phone: 502-484-3046
  • Fax: 502-484-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07586
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CULL
Title or Position: PRESIDENT,OWNER,AO
Credential: RPH
Phone: 502-484-3611