Organization
AUDUBON PHARMACY INC
Active
Other names
AUDUBON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TRACI ULLOM RPH (OWNER)
(502) 371-1002
Entity
Organization
Contact information
Practice address
3503 POPLAR LEVEL RD, LOUISVILLE, KY 40213-1009
(502) 371-1002
(502) 371-1005
Mailing address
3503 POPLAR LEVEL RD, LOUISVILLE, KY 40213-1009
(502) 371-1002
(502) 371-1005
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07058
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2034337
PK
—
05
—
54011911
—
KY
Enumeration date
09/20/2006
Last updated
12/29/2015
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