=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881107985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APOTHECARE PHARMACY OF ELIZABETHTOWN P S C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2017
-----------------------------------------------------
Last Update Date | 01/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1016 N MULBERRY ST
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-2173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-763-0303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1016 N MULBERRY ST
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-2173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-763-0303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GARY A HAMM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-739-0303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | P07861
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------