Provider Demographics
NPI:1982200333
Name:DEAL, RODERICK DAVIDSON (RPH)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:DAVIDSON
Last Name:DEAL
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 1:108 ROSE HILL CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-1855
Mailing Address - Country:US
Mailing Address - Phone:615-519-1232
Mailing Address - Fax:
Practice Address - Street 1:426 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2424
Practice Address - Country:US
Practice Address - Phone:615-321-2776
Practice Address - Fax:615-321-5094
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5535OtherPHARMACIST