Provider Demographics
NPI:1164592705
Name:CAIN, ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CAIN
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 1:7455 HANSON RD
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:KY
Mailing Address - Zip Code:42413-9415
Mailing Address - Country:US
Mailing Address - Phone:270-322-1234
Mailing Address - Fax:
Practice Address - Street 1:7455 HANSON RD
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:KY
Practice Address - Zip Code:42413-9415
Practice Address - Country:US
Practice Address - Phone:270-322-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist