Provider Demographics
NPI:1235253444
Name:EASLEY, ROBERT PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:EASLEY
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 1:3148 HOCHSTRASSER RD
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-8413
Mailing Address - Country:US
Mailing Address - Phone:502-477-2059
Mailing Address - Fax:
Practice Address - Street 1:7519 OUTER LOOP
Practice Address - Street 2:VALU MARKET PHARMACY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1726
Practice Address - Country:US
Practice Address - Phone:502-231-2424
Practice Address - Fax:502-231-8748
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007729OtherPHARMACIST LICENSE