Provider Demographics
NPI:1467863944
Name:EARLS, RAY ELMO (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:ELMO
Last Name:EARLS
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 1:5378 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5616
Mailing Address - Country:US
Mailing Address - Phone:513-451-1994
Mailing Address - Fax:513-451-2994
Practice Address - Street 1:5378 PALISADES DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5616
Practice Address - Country:US
Practice Address - Phone:513-451-1994
Practice Address - Fax:513-451-2994
Is Sole Proprietor?:No
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist