Provider Demographics
NPI:1912774050
Name:KY PHARMACY
Entity Type:Organization
Organization Name:KY PHARMACY
Other - Org Name:KENTUCKY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:VY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-975-0705
Mailing Address - Street 1:4102 SANCTUARY BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5872
Mailing Address - Country:US
Mailing Address - Phone:781-975-0705
Mailing Address - Fax:502-415-7346
Practice Address - Street 1:2233 LOWER HUNTERS TRCE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1358
Practice Address - Country:US
Practice Address - Phone:502-289-3797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy