Organization
ELY DRUGS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS KYLE HUDNALL PH.D. BCPS (OWNER/PRESIDENT)
(270) 651-8359
Entity
Organization
Contact information
Practice address
415 HAPPY VALLEY ROAD, GLASGOW, KY 42141
(270) 651-8359
(270) 651-5741
Mailing address
P.O. BOX 1778, GLASGOW, KY 42141-1778
(270) 651-8359
(270) 651-5741
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
P07216
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000069929
DME
KY
01
—
69929
DME
KY
05
—
90150053
—
KY
Enumeration date
07/11/2005
Last updated
01/27/2009
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