Provider Demographics
NPI:1932482031
Name:PULLIAM, DARREN LAVELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:LAVELL
Last Name:PULLIAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1747
Mailing Address - Country:US
Mailing Address - Phone:502-348-2985
Mailing Address - Fax:502-348-7067
Practice Address - Street 1:824 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1747
Practice Address - Country:US
Practice Address - Phone:502-348-2985
Practice Address - Fax:502-348-7067
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist