Provider Demographics
NPI:1730280975
Name:FELTS, RONNIE R (DPH)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:R
Last Name:FELTS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7164 WHITES CREEK PIKE
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080-8632
Mailing Address - Country:US
Mailing Address - Phone:615-876-0633
Mailing Address - Fax:615-876-0080
Practice Address - Street 1:7164 WHITES CREEK PIKE
Practice Address - Street 2:
Practice Address - City:JOELTON
Practice Address - State:TN
Practice Address - Zip Code:37080-8632
Practice Address - Country:US
Practice Address - Phone:615-876-0633
Practice Address - Fax:615-876-0080
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4172690001Medicare NSC