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General NPI Number Information
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NPI Number | 1265530034
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Entity Type | Organization
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Legal Business Name | CENTRAL STATE HOSPITAL PHARMACY
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 10510 LAGRANGE RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-1277
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Country | US
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Telephone | 502-253-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 10510 LAGRANGE RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-1277
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HOSPITAL DIRECTOR
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Name | MS. PATRICIA P BRODIE
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Credential |
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Telephone | 502-253-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | P05065
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License Number State | KY
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