Etown Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P07451 Issued in KY

Legal business name

ETOWN PHARMACY LLC

Doing business as

Etown Pharmacy

Practice address

914 N Dixie Ave Ste 103
Elizabethtown, KY 42701-2536

Phone

(270) 900-1583

Fax

(270) 900-1594

NPI assigned

Jun 13, 2011

Organization subpart

No

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

Authorized official

Name

Mohammed Shajiuddin

Title

Owner, Administrator

Phone

(615) 686-6420

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Etown Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

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

{
    "created_epoch": "1307923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593561600000",
    "number": "1295020741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 N DIXIE AVE STE 103",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012536",
            "telephone_number": "270-900-1583",
            "fax_number": "270-900-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 N DIXIE AVE STE 103",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012536",
            "telephone_number": "270-900-1583",
            "fax_number": "270-900-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETOWN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-13",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A",
        "authorized_official_last_name": "SHAJIUDDIN",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER, ADMINISTRATOR",
        "authorized_official_telephone_number": "615-686-6420"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07451",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100170610",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2130699",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Etown Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Etown Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Community/Retail Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.