Healthcare Provider Details

I. General information

NPI: 1578485322
Provider Name (Legal Business Name): RONALD TRACY GERKEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WATERFRONT DR APT 323
ST SIMONS IS GA
31522-2310
US

IV. Provider business mailing address

20 WATERFRONT DR APT 323
ST SIMONS IS GA
31522-2310
US

V. Phone/Fax

Practice location:
  • Phone: 912-269-2074
  • Fax:
Mailing address:
  • Phone: 912-269-2074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH015345
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: