MEDICARE: ST. MATTHEWS PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1295665750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MATTHEWS PHARMACY LLC

Provider Business Mailing Address
First Line	:	9500 ORMSBY STATION RD STE 400
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4076
Country	:	US
Telephone Number	:	502-406-2107
Fax Number	:	844-601-3442

Provider Business Practice Location Address
First Line	:	2105 CRUMS LN # 100
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-4231
Country	:	US
Telephone Number	:	502-406-2107
Fax Number	:	844-601-3442

Authorized Official
Title or Position	:	PHARMACY ADMINISTRATIVE SPECIALIST
Name	:	FARA TIPPIT
Credential	:
Telephone Number	:	502-760-0089

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	06/11/2026

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