Provider Demographics
NPI:1407377112
Name:ROYSTER, RICH RAY
Entity Type:Individual
Prefix:
First Name:RICH
Middle Name:RAY
Last Name:ROYSTER
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 1:3800 NW 79TH TER APT 284
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-0052
Mailing Address - Country:US
Mailing Address - Phone:352-284-7282
Mailing Address - Fax:
Practice Address - Street 1:5200 NW 43RD ST # 401
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4484
Practice Address - Country:US
Practice Address - Phone:352-284-7282
Practice Address - Fax:352-284-7282
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist