Healthcare Provider Details

I. General information

NPI: 1801164348
Provider Name (Legal Business Name): APOTHECARE PHARMACY OF ELIZABETHTOWN P S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 E LINCOLN TRAIL BLVD
RADCLIFF KY
40160-1253
US

IV. Provider business mailing address

189 E LINCOLN TRAIL BLVD
RADCLIFF KY
40160-1253
US

V. Phone/Fax

Practice location:
  • Phone: 270-352-0303
  • Fax: 270-352-0101
Mailing address:
  • Phone: 270-352-0303
  • Fax: 270-352-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07481
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GARY HAMM
Title or Position: PRESIDENT
Credential:
Phone: 270-234-3907