Provider Demographics
NPI:1336140912
Name:HORNBECK, RONNIE CARROL
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:CARROL
Last Name:HORNBECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 OLD POND LN
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-3360
Mailing Address - Country:US
Mailing Address - Phone:615-322-3884
Mailing Address - Fax:
Practice Address - Street 1:21ST AVE. S.
Practice Address - Street 2:RM 1815 TVC
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-3884
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist