Provider Demographics
NPI:1518230598
Name:SOUTHARD, RONALD DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DEAN
Last Name:SOUTHARD
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 1:2343 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0254
Mailing Address - Country:US
Mailing Address - Phone:248-972-0725
Mailing Address - Fax:248-972-0570
Practice Address - Street 1:2343 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48302-0254
Practice Address - Country:US
Practice Address - Phone:248-972-0725
Practice Address - Fax:248-972-0570
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist