Organization
ELY SPECIAL PHARMACY INC.
Active
Other names
Ely Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS HUDNALL (OWNER)
(270) 467-5225
Entity
Organization
Contact information
Practice address
4863C SCOTTSVILLE RD, BOWLING GREEN, KY 42104-7909
(270) 467-5225
Mailing address
4863C SCOTTSVILLE RD, BOWLING GREEN, KY 42104-7909
(270) 467-5225
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
Primary
P07674
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150829
PK
—
Enumeration date
03/18/2015
Last updated
03/18/2015
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