Provider Demographics
NPI:1093746190
Name:EMBERTON, KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:EMBERTON
Suffix:
Gender:M
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:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-0479
Mailing Address - Country:US
Mailing Address - Phone:270-432-3111
Mailing Address - Fax:
Practice Address - Street 1:1704 W STOCKTON ST
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8137
Practice Address - Country:US
Practice Address - Phone:270-432-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist