Active NPI
Robert Mack Pemberton, RPH
- Pharmacist
- Elizabethtown, KY
National Provider Identifier
1669757563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- KY013986
- Practice address
- 1602 N Dixie Hwy
Elizabethtown, KY 42701-2682 - Phone
- (270) 737-3713
- NPI assigned
- Oct 12, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | KY013986 | KY | Primary |
Addresses
Primary practice location
1602 N Dixie Hwy
Elizabethtown, KY 42701-2682
Mailing address
12600 Razor CT
Louisville, KY 40299-4595
Phone (865) 805-9169
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY013986 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318377600000",
"number": "1669757563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12600 RAZOR CT",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402994595",
"telephone_number": "865-805-9169"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1602 N DIXIE HWY",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427012682",
"telephone_number": "270-737-3713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEMBERTON",
"first_name": "ROBERT",
"middle_name": "MACK",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-12",
"last_updated": "2011-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "KY013986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.