Provider Demographics
NPI:1699292474
Name:HERRINGTON, RON (RPH)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:HERRINGTON
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 1:2675 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-7431
Mailing Address - Country:US
Mailing Address - Phone:601-764-4342
Mailing Address - Fax:601-764-3558
Practice Address - Street 1:2675 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-7431
Practice Address - Country:US
Practice Address - Phone:601-764-4342
Practice Address - Fax:601-764-3558
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1851318323OtherNPI