Provider Demographics
NPI:1023505617
Name:HANCE, CATHY (RPH)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:HANCE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 SHELBYVILLE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1094
Mailing Address - Country:US
Mailing Address - Phone:502-244-6500
Mailing Address - Fax:502-244-6588
Practice Address - Street 1:12121 SHELBYVILLE RD STE 107
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1094
Practice Address - Country:US
Practice Address - Phone:502-244-6500
Practice Address - Fax:502-244-6588
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY98091835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100050380Medicaid