Provider Demographics
NPI:1235188640
Name:VISE, RONNIE (DPH)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:VISE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 TENNESSEE AVE N
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-2002
Mailing Address - Country:US
Mailing Address - Phone:731-847-3784
Mailing Address - Fax:731-847-6167
Practice Address - Street 1:179 TENNESSEE AVE N
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2002
Practice Address - Country:US
Practice Address - Phone:731-847-3784
Practice Address - Fax:731-847-6167
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist