Provider Demographics
NPI:1366611832
Name:UNIVERSITY OF KENTUCKY
Entity type:Organization
Organization Name:UNIVERSITY OF KENTUCKY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:EAGLE
Authorized Official - Last Name:KINGERY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-439-1559
Mailing Address - Street 1:59 COWTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822
Mailing Address - Country:US
Mailing Address - Phone:606-785-3178
Mailing Address - Fax:606-785-9969
Practice Address - Street 1:59 COWTOWN RD
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822
Practice Address - Country:US
Practice Address - Phone:606-785-3175
Practice Address - Fax:606-435-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY072423336C0003X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY07242OtherPHARMACY PERMIT NUMBER