Pharmacy Name MedVantx Specialty Pharmacy
Address 1860 Outer Loop Ste 348
Louisville, KY 40219
Phone (502) 961-7295 or (844) 877-8444
Pharmacist in Charge Patrick Southall
Professional Degree BS Pharmacy, University of Kentucky, 1991
MBA, Northwestern University / Chulalongkorn U, 2009
Six Sigma Green Belt Certified, 2013
STATE License Number
ALABAMA 114459
ALASKA 1486
ARIZONA Y006139
ARKANSAS OS02580, PD13595
CALIFORNIA 1576
COLORADO OSP.0006567
CONNECTICUT PCN.0002829
DELAWARE A9-0001590, PH0010653
FLORIDA PH28438
GEORGIA PHNR000731
HAWAII PMP1022
IDAHO 37730MS
ILLINOIS 054018806, 320011039
INDIANA 64001804A, 26026002A
IOWA 4442
KANSAS 22-44628
KENTUCKY P07637, 010278
LOUISIANA PHY.007091-NR, PST.021429
MAINE MO40001771
MARYLAND P06689
MASSACHUSETTS Not Required
MICHIGAN 5301010755, 5315073576
MINNESOTA 264628
MISSISSIPPI 13617/7.1, CS13617/7.1, T14152T-13427
MISSOURI 2014037460
MONTANA PHA-MOP-LIC-28566
NEBRASKA 901, 15173
NEVADA PH03305
NEW HAMPSHIRE NR1215
NEW JERSEY 28RO00114600
NEW MEXICO PH00003906, CS00221573
NEW YORK 033294
NORTH CAROLINA 12521
NORTH DAKOTA PHAR1093
OHIO NRP.022454950-03
OKLAHOMA 99-6943
OREGON RP-0003023
PENNSYLVANIA Pending
RHODE ISLAND CPHN10712
SOUTH CAROLINA 15908
SOUTH DAKOTA 400-1322, 6004
TENNESSEE 5440, 40928
TEXAS 29796, 60175
UTAH 9132230-1708, 9132230-8913
VERMONT 036.0106327
VIRGINIA 0214001631, 202215561
WASHINGTON PHNR.FO.60502234
WEST VIRGINIA MO0560756, MI0000788, RP0010018
WISCONSIN 1298
WYOMING NR-50835, CSB00120