Provider Demographics
NPI:1144412784
Name:STICKRATH, ROD BLAINE (RPH)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:BLAINE
Last Name:STICKRATH
Suffix:
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 MAYSVILLE AVE.
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9797
Mailing Address - Country:US
Mailing Address - Phone:740-454-8331
Mailing Address - Fax:740-453-3976
Practice Address - Street 1:15 MAYSVILLE AVE.
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-9797
Practice Address - Country:US
Practice Address - Phone:740-454-8331
Practice Address - Fax:740-453-3976
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03311912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist