Provider Demographics
NPI:1831360544
Name:RYALS DRUG STORE
Entity type:Organization
Organization Name:RYALS DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPHARMACIST
Authorized Official - Phone:229-868-6735
Mailing Address - Street 1:112 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-1539
Mailing Address - Country:US
Mailing Address - Phone:912-868-6735
Mailing Address - Fax:
Practice Address - Street 1:112 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:MC RAE
Practice Address - State:GA
Practice Address - Zip Code:31055-1539
Practice Address - Country:US
Practice Address - Phone:912-868-6735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1155360001Medicare NSC