Provider Demographics
NPI:1295190833
Name:UNIVERSITY OF KENTUCKY
Entity Type:Organization
Organization Name:UNIVERSITY OF KENTUCKY
Other - Org Name:UK SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF PAYER ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:DEBORD
Authorized Official - Last Name:YOUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:FHFMA
Authorized Official - Phone:859-257-9521
Mailing Address - Street 1:531 WELLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1482
Mailing Address - Country:US
Mailing Address - Phone:859-218-5413
Mailing Address - Fax:859-323-5861
Practice Address - Street 1:531 WELLINGTON WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1482
Practice Address - Country:US
Practice Address - Phone:859-218-5413
Practice Address - Fax:859-323-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336H0001X
KYP077303336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54008230Medicaid
KY0767120001Medicare PIN