Provider Demographics
NPI:1225521081
Name:BN SPECIALTY, LLC
Entity Type:Organization
Organization Name:BN SPECIALTY, LLC
Other - Org Name:BN SPECIALTY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BACH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-792-8258
Mailing Address - Street 1:5111 COMMERCE CROSSINGS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2191
Mailing Address - Country:US
Mailing Address - Phone:502-792-8258
Mailing Address - Fax:502-792-8158
Practice Address - Street 1:5111 COMMERCE CROSSINGS DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2192
Practice Address - Country:US
Practice Address - Phone:502-792-8258
Practice Address - Fax:502-792-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP080023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177986OtherPK