Healthcare Provider Details

I. General information

NPI: 1588902894
Provider Name (Legal Business Name): APOTHECARE PHARMACY OF ELIZABETHTOWN P S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CRUTCHER ST
VINE GROVE KY
40175-1409
US

IV. Provider business mailing address

107 CRUTCHER ST
VINE GROVE KY
40175-1409
US

V. Phone/Fax

Practice location:
  • Phone: 270-877-5111
  • Fax: 270-877-1333
Mailing address:
  • Phone: 270-877-5111
  • Fax: 270-877-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07543
License Number StateKY

VIII. Authorized Official

Name: MR. GARY ALLEN HAMM
Title or Position: PRESIDENT/OWNER/MANAGER
Credential: RPH
Phone: 270-234-3907