Provider Demographics
NPI:1942580485
Name:DORR, RALPH (RPH)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:DORR
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 1:7130 FULTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62670-6787
Mailing Address - Country:US
Mailing Address - Phone:217-816-6886
Mailing Address - Fax:
Practice Address - Street 1:7130 FULTON RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:IL
Practice Address - Zip Code:62670-6787
Practice Address - Country:US
Practice Address - Phone:217-816-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051026530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist