Provider Demographics
NPI:1265037113
Name:RATLIFF, BRYAN TODD (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:TODD
Last Name:RATLIFF
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 1:21261 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-5507
Mailing Address - Country:US
Mailing Address - Phone:276-676-0019
Mailing Address - Fax:
Practice Address - Street 1:241 GATEWAY PLZ STE 105
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3350
Practice Address - Country:US
Practice Address - Phone:276-386-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist