Provider Demographics
NPI:1295010833
Name:ETOWN INFUSION PHARMACY LLC
Entity Type:Organization
Organization Name:ETOWN INFUSION PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOONUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-525-3142
Mailing Address - Street 1:914 N DIXIE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2520
Mailing Address - Country:US
Mailing Address - Phone:270-506-2463
Mailing Address - Fax:
Practice Address - Street 1:914 N DIXIE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2520
Practice Address - Country:US
Practice Address - Phone:270-506-2463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07475332B00000X, 332BP3500X, 3336H0001X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100228060Medicaid
2132664OtherPK
KY50037219Medicaid
KY7100185430Medicaid
6700380001Medicare NSC