Provider Demographics
NPI:1205821808
Name:NELSON, RONALD DAVID (PHARMD, BCPP)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DAVID
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 S PALMWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2841
Mailing Address - Country:US
Mailing Address - Phone:206-850-6380
Mailing Address - Fax:321-637-3570
Practice Address - Street 1:2900 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8007
Practice Address - Country:US
Practice Address - Phone:321-637-3788
Practice Address - Fax:321-637-3570
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000407571835P1300X
MN11636031835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric