Provider Demographics
NPI:1154734093
Name:DAVIS, ROBERT EARL II (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 RIVER CLIFF BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1443
Mailing Address - Country:US
Mailing Address - Phone:270-980-0677
Mailing Address - Fax:
Practice Address - Street 1:610 BYPASS RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1730
Practice Address - Country:US
Practice Address - Phone:270-422-5300
Practice Address - Fax:270-422-7950
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist