Provider Demographics
NPI:1306970140
Name:COVINGTON, RALPH MILTON
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:MILTON
Last Name:COVINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RALPH
Other - Middle Name:MILTON
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:399 FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ODUM
Mailing Address - State:GA
Mailing Address - Zip Code:31555-9565
Mailing Address - Country:US
Mailing Address - Phone:912-427-6280
Mailing Address - Fax:
Practice Address - Street 1:192 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1309
Practice Address - Country:US
Practice Address - Phone:912-427-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist