Provider Demographics
NPI:1104813674
Name:NORRIS, RONALD EDGAR (PD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:EDGAR
Last Name:NORRIS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-2111
Mailing Address - Country:US
Mailing Address - Phone:870-222-3080
Mailing Address - Fax:870-222-6561
Practice Address - Street 1:712 HOLLY ST
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-2111
Practice Address - Country:US
Practice Address - Phone:870-222-3080
Practice Address - Fax:870-222-6561
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist