Provider Demographics
NPI:1699574558
Name:HANCOCK, SALLY SMITH (PHARMD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:SMITH
Last Name:HANCOCK
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-6107
Mailing Address - Country:US
Mailing Address - Phone:270-522-3441
Mailing Address - Fax:
Practice Address - Street 1:435 LAKOTA DR
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-6107
Practice Address - Country:US
Practice Address - Phone:270-522-3441
Practice Address - Fax:270-522-1616
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist