Provider Demographics
NPI:1407949464
Name:MABIE, RONALD B (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:B
Last Name:MABIE
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 1:439 CONNIE ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9613
Mailing Address - Country:US
Mailing Address - Phone:608-839-4917
Mailing Address - Fax:
Practice Address - Street 1:21 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536-1143
Practice Address - Country:US
Practice Address - Phone:608-882-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR8248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist