Provider Demographics
NPI:1639298607
Name:ALLEY, RALPH CLAYTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:CLAYTON
Last Name:ALLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6117 ALLEE WAY
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-6033
Mailing Address - Country:US
Mailing Address - Phone:770-364-2812
Mailing Address - Fax:
Practice Address - Street 1:5915 SPOUT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-4005
Practice Address - Country:US
Practice Address - Phone:770-967-1664
Practice Address - Fax:770-967-1955
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0011768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist