Organization
FAMILY HEALTH CENTER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL RIDDICK (CEO)
(502) 774-8631
Entity
Organization
Contact information
Practice address
2215 PORTLAND AVE, LOUISVILLE, KY 40212-1033
(502) 774-8631
Mailing address
PO BOX 950244, LOUISVILLE, KY 40295-0244
(502) 774-8631
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1810894
NCPDP
—
05
—
54006044
—
KY
01
—
P01226
STATE LICENSE
KY
Enumeration date
10/25/2006
Last updated
05/07/2026
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