Provider Demographics
NPI:1871826800
Name:TAYLOR, RONNIE NATHAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:NATHAN
Last Name:TAYLOR
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 1:38 CRAWFORD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6284
Mailing Address - Country:US
Mailing Address - Phone:334-671-3707
Mailing Address - Fax:
Practice Address - Street 1:2020 ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3004
Practice Address - Country:US
Practice Address - Phone:334-673-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist