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General NPI Number Information
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NPI Number | 1699319814
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Entity Type | Organization
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Legal Business Name | ST. MATTHEWS PHARMACY LLC
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 200 N HURSTBOURNE PKWY STE 174
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City | LOUISVILLE
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State | KY
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Zip | 40222-5138
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Country | US
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Telephone | 502-690-4462
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Fax | 502-690-4466
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Provider Business Mailing Address
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Address Line | 9500 ORMSBY STATION RD STE 400
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City | LOUISVILLE
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State | KY
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Zip | 40223-4076
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Country | US
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Telephone | 502-690-4462
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRADLEY ECKMANN
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Credential |
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Telephone | 502-690-4462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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