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General NPI Number Information
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NPI Number | 1144320631
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Entity Type | Individual
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Provider Name | ROBERT BRYAN MCMAHAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 W MAIN ST HUM 17
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City | LOUISVILLE
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State | KY
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Zip | 40202-2946
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Country | US
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Telephone | 502-580-2401
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Fax | 502-508-2401
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Provider Business Mailing Address
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Address Line | 1148 S 1ST ST APARTMENT #1
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City | LOUISVILLE
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State | KY
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Zip | 40203-2804
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Country | US
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Telephone | 502-580-2401
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Fax | 502-508-2401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 012867
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License Number State | KY
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