Provider Demographics
NPI:1760074298
Name:CANNON, RALPH DONALD JR (RPH)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:DONALD
Last Name:CANNON
Suffix:JR
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 1:1233 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2258
Mailing Address - Country:US
Mailing Address - Phone:864-582-8280
Mailing Address - Fax:
Practice Address - Street 1:1233 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2258
Practice Address - Country:US
Practice Address - Phone:864-582-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11081183500000X
SC7223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist