Provider Demographics
NPI:1235184078
Name:SOPOREX RESPIRATORY INC
Entity Type:Organization
Organization Name:SOPOREX RESPIRATORY INC
Other - Org Name:INDEPENDENCE HOME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-753-5250
Mailing Address - Street 1:1306 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-9302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1306 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-9302
Practice Address - Country:US
Practice Address - Phone:270-753-5205
Practice Address - Fax:270-753-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO71123336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1829564OtherOTHER ID NUMBER-COMMERCIAL NUMBER