MEDICARE: MR. RAY ELMO EARLS RPH

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	03215554	OH

General Provider Information

NPI Number	:	1467863944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAY ELMO EARLS RPH

Provider Business Mailing Address
First Line	:	5378 PALISADES DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-5616
Country	:	US
Telephone Number	:	513-451-1994
Fax Number	:	513-451-2994

Provider Business Practice Location Address
First Line	:	5378 PALISADES DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-5616
Country	:	US
Telephone Number	:	513-451-1994
Fax Number	:	513-451-2994

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

Provider Enumeration Date	:	05/18/2014
Last Update Date	:	05/18/2014

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