Provider Demographics
NPI:1073609731
Name:UNIVERSITY OF KENTUCKY
Entity Type:Organization
Organization Name:UNIVERSITY OF KENTUCKY
Other - Org Name:UNIVERSITY OF KENTUCKY CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF PAYER ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:DEBORD
Authorized Official - Last Name:YOUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-257-9521
Mailing Address - Street 1:740 S LIMESTONE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5855
Mailing Address - Fax:859-257-3828
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5855
Practice Address - Fax:859-257-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP01621332B00000X, 3336C0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001474002Medicaid
KY45543592Medicaid
KY54008230Medicaid
KY90870346Medicaid
KY90870346Medicaid