Provider Demographics
NPI:1033663471
Name:NIX, RALPH EMERSON II (RPH)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:EMERSON
Last Name:NIX
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CALLISTO DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-3426
Mailing Address - Country:US
Mailing Address - Phone:706-202-2671
Mailing Address - Fax:
Practice Address - Street 1:15 CALLISTO DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30683-3426
Practice Address - Country:US
Practice Address - Phone:706-202-2671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist