Provider Demographics
NPI:1619190550
Name:CARTER, RALPH PHILLIP (RPH)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:PHILLIP
Last Name:CARTER
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 1:310 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5556
Mailing Address - Country:US
Mailing Address - Phone:478-275-0287
Mailing Address - Fax:
Practice Address - Street 1:2101 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3033
Practice Address - Country:US
Practice Address - Phone:478-275-7990
Practice Address - Fax:478-272-5496
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist