MEDICARE: MR. RONALD CLYDE ABERNATHY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202005063	VA

General Provider Information

NPI Number	:	1144500661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD CLYDE ABERNATHY

Provider Business Mailing Address
First Line	:	26036 COX RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-6566
Country	:	US
Telephone Number	:	804-863-4922
Fax Number	:	804-863-4928

Provider Business Practice Location Address
First Line	:	26036 COX RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-6566
Country	:	US
Telephone Number	:	804-863-4922
Fax Number	:	804-863-4928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	08/29/2011

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