NPIMap

Organization Active NPI

Middletown Pharmacist Group

Doing business as Middletown Pharmacy & Wellness-LTC

  • Long Term Care Pharmacy
  • Louisville, KY
National Provider Identifier
1164151585
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
MIDDLETOWN PHARMACIST GROUP
Doing business as
Middletown Pharmacy & Wellness-LTC
Practice address
11601 Shelbyville Rd Ste a
Louisville, KY 40243-1309
Phone
(502) 690-2410
NPI assigned
Jun 9, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Boggess
Title
Owner
Phone
(502) 690-2410

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

11601 Shelbyville Rd Ste a
Louisville, KY 40243-1309

Mailing address

11601 Shelbyville Rd Ste a
Louisville, KY 40243-1309
Phone (502) 690-2410

Other identifiers 1

IdentifierTypeStateIssuer
7100717140MedicaidKY

Other names 1

  • Middletown Pharmacy & Wellness-LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Middletown Pharmacist Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11601 Shelbyville Rd
#A
Louisville, KY 40243
Phone (502) 690-2410

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1164151585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11601 SHELBYVILLE RD STE A",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402431309",
            "telephone_number": "502-690-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11601 SHELBYVILLE RD STE A",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402431309",
            "telephone_number": "502-690-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLETOWN PHARMACIST GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-06",
        "status": "A",
        "authorized_official_last_name": "BOGGESS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-690-2410"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100717140",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Middletown Pharmacy & Wellness-LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.