Provider Demographics
NPI:1093798613
Name:POOLE, RONALD STEVEN (RPH)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:STEVEN
Last Name:POOLE
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 1:900 W WHITMER ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-2053
Mailing Address - Country:US
Mailing Address - Phone:270-754-1541
Mailing Address - Fax:270-754-9069
Practice Address - Street 1:102 W BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1538
Practice Address - Country:US
Practice Address - Phone:270-754-1545
Practice Address - Fax:270-754-9069
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10110183500000X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10110OtherPHARMACIST LICENSE #
KY54006341Medicaid
KY0710080001Medicare ID - Type UnspecifiedMEDICARE DME#