Provider Demographics
NPI:1578239562
Name:HOPPENRATH, ARIEL JAYDE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:JAYDE
Last Name:HOPPENRATH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:JAYDE
Other - Last Name:HOPPENRATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:95 PARKERS LOOP APT 2
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1724
Mailing Address - Country:US
Mailing Address - Phone:270-317-9246
Mailing Address - Fax:
Practice Address - Street 1:150 RALEIGH DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7139
Practice Address - Country:US
Practice Address - Phone:270-234-8111
Practice Address - Fax:270-234-8195
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54011192Medicaid