Organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Active
Parent organization
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Other names
Park Duvalle Newburg Community Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC
Authorized official
SWANNIE JETT (CEO)
(502) 774-4401
Entity
Organization
Contact information
Practice address
3828 BARDSTOWN RD, LOUISVILLE, KY 40218-1527
(502) 479-8930
Mailing address
3015 WILSON AVE, LOUISVILLE, KY 40211-1969
(502) 774-4401
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31000011
—
KY
01
—
P08243
PHARMACY LIC
KY
Enumeration date
09/21/2022
Last updated
09/21/2022
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