Provider Demographics
NPI:1245543594
Name:KEYLON, RONNIE CHARLES (PHARMD)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:CHARLES
Last Name:KEYLON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 DIXON FARM RD
Mailing Address - Street 2:
Mailing Address - City:WALLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37886-2153
Mailing Address - Country:US
Mailing Address - Phone:865-983-6937
Mailing Address - Fax:
Practice Address - Street 1:1302 CONGRESS PKWY S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4907
Practice Address - Country:US
Practice Address - Phone:423-745-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9937183500000X
WV5232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist