Provider Demographics
NPI:1235990615
Name:KENTUCKY PHARMACY #1, LLC
Entity Type:Organization
Organization Name:KENTUCKY PHARMACY #1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:502-437-3008
Mailing Address - Street 1:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40066-1248
Mailing Address - Country:US
Mailing Address - Phone:502-437-3008
Mailing Address - Fax:502-437-3607
Practice Address - Street 1:182 FRANKFORT RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9433
Practice Address - Country:US
Practice Address - Phone:502-437-3008
Practice Address - Fax:502-437-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy