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General NPI Number Information
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NPI Number | 1780247288
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Entity Type | Organization
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Legal Business Name | ELY EXTENDED CARE INC.
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 109 MORAN ST
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City | GLASGOW
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State | KY
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Zip | 42141-1632
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Country | US
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Telephone | 270-479-0340
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | GLASGOW
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State | KY
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Zip | 42142-0187
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Country | US
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Telephone | 270-479-0340
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Fax | 270-629-5769
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | LASHELLE ENNIS
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Credential |
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Telephone | 270-479-0340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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