MEDICARE: MR. RONALD STEVEN POOLE R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10110	KY
2	1835N1003X	Nutrition Support Pharmacist	10110	KY
3	1835P1200X	Pharmacotherapy Pharmacist	10110	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10110	OTHER	KY	PHARMACIST LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093798613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD STEVEN POOLE R.PH.

Provider Business Mailing Address
First Line	:	900 W WHITMER ST
Second Line	:
City	:	CENTRAL CITY
State	:	KY
Zip	:	42330-2053
Country	:	US
Telephone Number	:	270-754-1541
Fax Number	:	270-754-9069

Provider Business Practice Location Address
First Line	:	102 W BROAD ST
Second Line	:
City	:	CENTRAL CITY
State	:	KY
Zip	:	42330-1538
Country	:	US
Telephone Number	:	270-754-1545
Fax Number	:	270-754-9069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/11/2025

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