Organization
PUCKETT ULLOM INC
Active
Organization
PUCKETT ULLOM INC
Active
Other names
ROUBENS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN ULLOM RPH (OWNER)
(502) 458-3229
Entity
Organization
Contact information
Practice address
3501 POPLAR LEVEL RD, LOUISVILLE, KY 40213-1009
(502) 458-3229
(502) 452-6371
Mailing address
3501 POPLAR LEVEL RD, LOUISVILLE, KY 40213-1009
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PO6088
KY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1802241
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
54030069
—
KY
Enumeration date
10/07/2006
Last updated
09/11/2025
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