Provider Demographics
NPI:1285956672
Name:MADY, RON (RPH)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:
Last Name:MADY
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 1:240 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3203
Mailing Address - Country:US
Mailing Address - Phone:540-674-5261
Mailing Address - Fax:540-674-5254
Practice Address - Street 1:240 BROAD ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3203
Practice Address - Country:US
Practice Address - Phone:540-674-5261
Practice Address - Fax:540-674-5254
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist