Provider Demographics
NPI:1194995407
Name:SKELTON, RON W (RPH)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:W
Last Name:SKELTON
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 1:920 HIGHWAY 81 E
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-2978
Mailing Address - Country:US
Mailing Address - Phone:770-898-3593
Mailing Address - Fax:770-914-1975
Practice Address - Street 1:920 HIGHWAY 81 E
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-2978
Practice Address - Country:US
Practice Address - Phone:770-898-3593
Practice Address - Fax:770-914-1975
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist