# CENTRAL STATE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CENTRAL STATE HOSPITAL PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144467770
- **Authorized official:** JOE MCCULLEN (SENIOR CONTROLLER)
- **Authorized official phone:** (502) 253-7000

## Contact information

- **Practice address:** 10510 LA GRANGE RD, LOUISVILLE, KY 40223-1277
- **Practice address phone:** (502) 253-7337
- **Practice address fax:** (502) 253-7344
- **Mailing address:** 10510 LA GRANGE RD, LOUISVILLE, KY 40223-1277
- **Mailing address phone:** (502) 253-7337
- **Mailing address fax:** (502) 253-7344

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336I0012X | Institutional Pharmacy | P05065 | KY | Yes |

## Other

- **Enumeration date:** 01/20/2009
- **Last updated:** 04/22/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2118602 | PK | — |
| 05 | — | 54025408 | — | KY |