Provider Demographics
NPI:1154414662
Name:CHURCHMAN PHARMACY
Entity type:Organization
Organization Name:CHURCHMAN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-366-1798
Mailing Address - Street 1:4402 CHURCHMAN AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1190
Mailing Address - Country:US
Mailing Address - Phone:502-366-1798
Mailing Address - Fax:502-361-4334
Practice Address - Street 1:4402 CHURCHMAN AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-366-1798
Practice Address - Fax:502-361-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty