Provider Demographics
NPI:1427789478
Name:MAGGARD, RONALD NATHANIEL
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:NATHANIEL
Last Name:MAGGARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 SE FRANK PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-4025
Mailing Address - Country:US
Mailing Address - Phone:918-336-9411
Mailing Address - Fax:918-336-7099
Practice Address - Street 1:811 SE FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4025
Practice Address - Country:US
Practice Address - Phone:918-336-9411
Practice Address - Fax:918-336-7099
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist