Provider Demographics
NPI:1518041516
Name:ROBERT YOWLER
Entity type:Organization
Organization Name:ROBERT YOWLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:YOWLER
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:502-255-3540
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40006-0243
Mailing Address - Country:US
Mailing Address - Phone:502-255-3540
Mailing Address - Fax:502-255-3615
Practice Address - Street 1:325 HWY. 42 EAST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:KY
Practice Address - Zip Code:40006
Practice Address - Country:US
Practice Address - Phone:502-255-3540
Practice Address - Fax:502-255-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18D0950636291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
18D0950636OtherCLIA LAB #
1816048OtherNABP
KY54019153Medicaid
KY9001112300OtherMEDICAID DME SUPPLIER #
KYPO1566OtherKY PHARMACY
0266OtherFLU
063700001OtherMEDICARE DME SUPPLIER #
063700001OtherMEDICARE DME SUPPLIER #
KYPO1566OtherKY PHARMACY