Provider Demographics
NPI:1942998448
Name:DERBY PHARMACY LLC
Entity Type:Organization
Organization Name:DERBY PHARMACY LLC
Other - Org Name:LAGRANGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-758-1205
Mailing Address - Street 1:501 PARKER PL UNIT 100
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-2231
Mailing Address - Country:US
Mailing Address - Phone:502-265-0020
Mailing Address - Fax:502-265-0107
Practice Address - Street 1:501 PARKER PL UNIT 100
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-2231
Practice Address - Country:US
Practice Address - Phone:502-265-0020
Practice Address - Fax:502-265-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy