Provider Demographics
NPI:1770118994
Name:ROPER, PHILLIP (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:ROPER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2754
Mailing Address - Country:US
Mailing Address - Phone:270-629-4633
Mailing Address - Fax:270-629-4634
Practice Address - Street 1:742 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2754
Practice Address - Country:US
Practice Address - Phone:270-629-4633
Practice Address - Fax:270-629-4634
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist