Provider Demographics
NPI:1780152561
Name:RYMER, CHARLES GERALD (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:GERALD
Last Name:RYMER
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 1:456 HIGHWAY 24 E
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39631-4128
Mailing Address - Country:US
Mailing Address - Phone:601-645-9190
Mailing Address - Fax:
Practice Address - Street 1:456 HIGHWAY 24 E
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4128
Practice Address - Country:US
Practice Address - Phone:601-645-9190
Practice Address - Fax:601-645-9165
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist