Provider Demographics
NPI:1437811734
Name:ST MATTHEWS SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:ST MATTHEWS SPECIALTY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-314-0146
Mailing Address - Street 1:12015 E 46TH AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3107
Mailing Address - Country:US
Mailing Address - Phone:844-848-5955
Mailing Address - Fax:
Practice Address - Street 1:200 N HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5138
Practice Address - Country:US
Practice Address - Phone:844-690-4462
Practice Address - Fax:844-524-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies