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General NPI Number Information
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NPI Number | 1518408665
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Entity Type | Organization
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Legal Business Name | PET360 PHARMACY LLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 2815 WATTERSON TRL
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City | LOUISVILLE
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State | KY
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Zip | 40299-3868
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Country | US
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Telephone | 502-716-7301
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Fax | 866-253-0274
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Provider Business Mailing Address
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Address Line | 2815 WATTERSON TRL
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City | LOUISVILLE
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State | KY
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Zip | 40299-3868
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Country | US
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Telephone | 502-716-7301
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Fax | 866-253-0274
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Authorized Official
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Title or Position | PIC
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Name | JUSTIN MILLS
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Credential |
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Telephone | 502-716-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | P07685
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License Number State | KY
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