Provider Demographics
NPI:1548316888
Name:BISHOP, ROBERT SCOTT (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SCOTT
Last Name:BISHOP
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 1:475 N HIGHWAY 25 W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1576
Mailing Address - Country:US
Mailing Address - Phone:606-549-4300
Mailing Address - Fax:606-549-9799
Practice Address - Street 1:475 N HIGHWAY 25 W
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1576
Practice Address - Country:US
Practice Address - Phone:606-549-4300
Practice Address - Fax:606-549-9799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54034855Medicaid
KY54034855Medicaid