Provider Demographics
NPI:1982969598
Name:EUBANK, DAVID OWEN (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:OWEN
Last Name:EUBANK
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 1:401 JAMESTOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1327
Mailing Address - Country:US
Mailing Address - Phone:270-634-1576
Mailing Address - Fax:
Practice Address - Street 1:265 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1400
Practice Address - Country:US
Practice Address - Phone:270-932-3100
Practice Address - Fax:270-932-3104
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist