Etown Infusion Pharmacy LLC

Primary specialty

Home Infusion Therapy PharmacyTaxonomy code 3336H0001X

Legal business name

ETOWN INFUSION PHARMACY LLC

Doing business as

Etown Vital Care

Practice address

914 N Dixie Ave Ste 101
Elizabethtown, KY 42701-2536

Phone

(270) 506-2463

Fax

(270) 506-2466

NPI assigned

Dec 23, 2020

Organization subpart

No

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

Authorized official

Name

Navas Sofia Yoonus-Kunju

Title

Ceo

Phone

(615) 525-3142

Specialties & licenses 1

Addresses

Other names 1

• Etown Vital Care Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Home infusion therapy

Medicare-enrolled home infusion therapy supplier

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Etown Infusion Pharmacy LLC

  • Home Infusion Agency
  • Elizabethtown, KY
  • NPI 1295010833

  7810157567

  Same PAC ID

Locations

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608681600000",
    "number": "1578150629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 N DIXIE AVE STE 101",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012536",
            "telephone_number": "270-506-2463",
            "fax_number": "270-506-2466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 N DIXIE AVE STE 101",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427012536",
            "telephone_number": "270-506-2463",
            "fax_number": "270-506-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETOWN INFUSION PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-23",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "YOONUS-KUNJU",
        "authorized_official_first_name": "NAVAS",
        "authorized_official_middle_name": "SOFIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-525-3142"
    },
    "taxonomies": [
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Etown Vital Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Infusion Therapy Pharmacy in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Home Infusion Therapy Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.