Provider Demographics
NPI:1578150629
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:SOFIA
Authorized Official - Last Name:YOONUS-KUNJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-525-3142
Mailing Address - Street 1:914 N DIXIE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2536
Mailing Address - Country:US
Mailing Address - Phone:270-506-2463
Mailing Address - Fax:270-506-2466
Practice Address - Street 1:914 N DIXIE AVE STE 101
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2536
Practice Address - Country:US
Practice Address - Phone:270-506-2463
Practice Address - Fax:270-506-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy