Provider Demographics
NPI:1831863497
Name:HUMPHREY, MAGGIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:HUMPHREY
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 1:3832 LEE ADAMS LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1038
Mailing Address - Country:US
Mailing Address - Phone:270-230-6563
Mailing Address - Fax:
Practice Address - Street 1:4305 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1299
Practice Address - Country:US
Practice Address - Phone:502-350-5230
Practice Address - Fax:502-350-5231
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist