Organization
ETOWN PHARMACY LLC
Active
Other names
Etown Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMED SHAJIUDDIN (OWNER, ADMINISTRATOR)
(615) 686-6420
Entity
Organization
Contact information
Practice address
914 N DIXIE AVE STE 103, ELIZABETHTOWN, KY 42701-2536
(270) 900-1583
(270) 900-1594
Mailing address
914 N DIXIE AVE STE 103, ELIZABETHTOWN, KY 42701-2536
(270) 900-1583
(270) 900-1594
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07451
KY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130699
PK
—
05
—
7100170610
—
KY
Enumeration date
06/13/2011
Last updated
07/01/2020
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