MEDICARE: ELY HOME INFUSION INC.

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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	251F00000X	Home Infusion Agency
5	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
6	3336H0001X	Home Infusion Therapy Pharmacy	P07503	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2134817	OTHER		PK

General Provider Information

NPI Number	:	1568574416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELY HOME INFUSION INC.

Provider Business Mailing Address
First Line	:	620 PERIMETER DR STE 105
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4125
Country	:	US
Telephone Number	:	859-268-0080
Fax Number	:	859-268-0083

Provider Business Practice Location Address
First Line	:	620 PERIMETER DR STE 105
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4125
Country	:	US
Telephone Number	:	859-268-0080
Fax Number	:	859-268-0083

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRAVIS HUDNALL
Credential	:	R.PH.
Telephone Number	:	270-651-5159

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/19/2025

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Directions to “ELY HOME INFUSION INC. ” Practice Location

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