Provider Demographics
NPI:1912314642
Name:AMERIPHARM, INC
Entity Type:Organization
Organization Name:AMERIPHARM, INC
Other - Org Name:MEDVANTX SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-744-0621
Mailing Address - Street 1:1860 OUTER LOOP STE 348
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3429
Mailing Address - Country:US
Mailing Address - Phone:844-877-8444
Mailing Address - Fax:866-345-2757
Practice Address - Street 1:1860 OUTER LOOP STE 348
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3429
Practice Address - Country:US
Practice Address - Phone:844-877-8444
Practice Address - Fax:866-345-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336M0002X
KYP076373336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146826OtherPK