Provider Demographics
NPI:1568749406
Name:DAVID RATH NUTRITION, INC.
Entity Type:Organization
Organization Name:DAVID RATH NUTRITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE ELWOOD
Authorized Official - Last Name:RATH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RD, LD
Authorized Official - Phone:501-975-3662
Mailing Address - Street 1:2100 BROADWAY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1363
Mailing Address - Country:US
Mailing Address - Phone:501-975-3662
Mailing Address - Fax:501-975-3662
Practice Address - Street 1:2100 BROADWAY ST STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-1363
Practice Address - Country:US
Practice Address - Phone:501-975-3662
Practice Address - Fax:501-975-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty