Provider Demographics
NPI:1205197381
Name:BROUGHTON, ELOIS (RPH)
Entity Type:Individual
Prefix:
First Name:ELOIS
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-0622
Mailing Address - Country:US
Mailing Address - Phone:502-477-1973
Mailing Address - Fax:502-477-1975
Practice Address - Street 1:913 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-8713
Practice Address - Country:US
Practice Address - Phone:502-477-1973
Practice Address - Fax:502-477-1975
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist