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General NPI Number Information
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NPI Number | 1669141008
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Entity Type | Organization
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Legal Business Name | AFTON PHARMACY INC
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 4400 BRECKENRIDGE LN STE 100
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City | LOUISVILLE
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State | KY
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Zip | 40218-4082
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Country | US
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Telephone | 812-817-0198
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Fax | 812-827-2485
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Provider Business Mailing Address
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Address Line | 4400 BRECKENRIDGE LN STE 100
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City | LOUISVILLE
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State | KY
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Zip | 40218-4082
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Country | US
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Telephone | 812-817-0198
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Fax | 812-827-2485
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Authorized Official
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Title or Position | MANAGER
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Name | BRENDA ROBERTSON
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Credential |
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Telephone | 502-724-2018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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