Provider Demographics
NPI:1669771622
Name:ROBINSON, RANDALL KEITH (RPH)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:KEITH
Last Name:ROBINSON
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 1:629 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-6001
Mailing Address - Country:US
Mailing Address - Phone:859-234-6111
Mailing Address - Fax:859-234-0427
Practice Address - Street 1:629 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-6001
Practice Address - Country:US
Practice Address - Phone:859-234-6111
Practice Address - Fax:859-234-0427
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist