Provider Demographics
NPI:1750630026
Name:ARLEDGE, HOMER RANDY (RPH)
Entity Type:Individual
Prefix:
First Name:HOMER
Middle Name:RANDY
Last Name:ARLEDGE
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 1:1315 S PLEASANTBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1330
Mailing Address - Country:US
Mailing Address - Phone:864-299-3469
Mailing Address - Fax:864-277-3396
Practice Address - Street 1:1315 S PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1330
Practice Address - Country:US
Practice Address - Phone:864-299-3469
Practice Address - Fax:864-277-3396
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist