Provider Demographics
NPI:1679244636
Name:POLSTON, ALEXA RAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:RAE
Last Name:POLSTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 ROUTT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5238
Mailing Address - Country:US
Mailing Address - Phone:502-939-6131
Mailing Address - Fax:
Practice Address - Street 1:9407 NORTON COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7525
Practice Address - Country:US
Practice Address - Phone:502-805-2301
Practice Address - Fax:502-290-2862
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist