Provider Demographics
NPI:1467885251
Name:HUGENBERG, ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HUGENBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:NUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11901 STANDIFORD PLAZA DR
Mailing Address - Street 2:PHARMACY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-5906
Mailing Address - Country:US
Mailing Address - Phone:502-968-6766
Mailing Address - Fax:502-968-6744
Practice Address - Street 1:11901 STANDIFORD PLAZA DR
Practice Address - Street 2:PHARMACY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5906
Practice Address - Country:US
Practice Address - Phone:502-968-6766
Practice Address - Fax:502-968-6744
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist