Provider Demographics
NPI:1326326653
Name:BISHOP, RAYMOND JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOHN
Last Name:BISHOP
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 1:4000 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1502
Mailing Address - Country:US
Mailing Address - Phone:502-458-2611
Mailing Address - Fax:502-458-9811
Practice Address - Street 1:4000 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1502
Practice Address - Country:US
Practice Address - Phone:502-458-2611
Practice Address - Fax:502-458-9811
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6838OtherPHARMACIST LICENSE