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NPI 1568749406

NPI 1568749406 : DAVID RATH NUTRITION, INC. : LITTLE ROCK, AR

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General NPI Number Information
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    NPI Number           |    1568749406
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    Entity Type          |    Organization 
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    Legal Business Name  |    DAVID RATH NUTRITION, INC. 
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Dates
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    Enumeration Date     |    11/07/2011
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    Last Update Date     |    12/01/2025
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Provider Practice Location Address
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    Address Line         |    2100 BROADWAY ST STE 101 
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    City                 |    LITTLE ROCK
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    State                |    AR
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    Zip                  |    72206-1363
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    Country              |    US
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    Telephone            |    501-975-3662
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    Fax                  |    501-508-6553
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Provider Business Mailing Address
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    Address Line         |    2100 BROADWAY ST STE 101 
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    City                 |    LITTLE ROCK
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    State                |    AR
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    Zip                  |    72206-1363
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    Country              |    US
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    Telephone            |    501-975-3662
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    Fax                  |    501-508-6553
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |    MR. DAVID LAWRENCE ELWOOD RATH 
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    Credential           |    MA, RD, LD
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    Telephone            |    501-975-3662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    133V00000X
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    Taxonomy Name        |    Registered Dietitian
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    License Number       |    307
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    License Number State |    AR
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