Healthcare Provider Details

I. General information

NPI: 1447540653
Provider Name (Legal Business Name): MRS. ROBIN DENISE COMBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2011
Last Update Date: 04/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 MANCHESTER SQUARE SHPG CTR
MANCHESTER KY
40962-8779
US

IV. Provider business mailing address

560 MANCHESTER SQUARE SHPG CTR
MANCHESTER KY
40962-8779
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-2907
  • Fax: 606-599-8042
Mailing address:
  • Phone: 606-598-2907
  • Fax: 606-599-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012101
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: