Provider Demographics
NPI:1366855744
Name:PROFFITT, RON
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:PROFFITT
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 1:1001 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-9029
Mailing Address - Country:US
Mailing Address - Phone:828-544-6119
Mailing Address - Fax:828-544-6122
Practice Address - Street 1:1001 N GREEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-9029
Practice Address - Country:US
Practice Address - Phone:828-544-6119
Practice Address - Fax:828-544-6122
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist