Provider Demographics
NPI:1578104287
Name:MEDWIZ OF KENTUCKY, LLC
Entity Type:Organization
Organization Name:MEDWIZ OF KENTUCKY, LLC
Other - Org Name:MEDWIZ PHAMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARON
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-825-9089
Mailing Address - Street 1:116 VENTURE CT STE 4-5-6
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2625
Mailing Address - Country:US
Mailing Address - Phone:859-479-3990
Mailing Address - Fax:859-479-3989
Practice Address - Street 1:116 VENTURE CT SUITES 4-5-6
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2625
Practice Address - Country:US
Practice Address - Phone:859-479-3990
Practice Address - Fax:859-479-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy