Provider Demographics
NPI:1750482998
Name:RONNIE FELTS
Entity Type:Organization
Organization Name:RONNIE FELTS
Other - Org Name:JOELTON PRESCRIPTION SHOP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:615-876-0633
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN9333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2094782OtherNCPDP
TN2094782OtherNCPDP
TN1750482998Medicare NSC