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NPI Code Detail

MEDICARE: RYAN RABON, INC.

MEDICARE: RYAN RABON, INC.
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
1333600000XPharmacy007978GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11142532OTHERGANABP NUMBER

General Provider Information

NPI Number : 1376608133
Entity Type Code : Organization
Provider Name (Legal Business Name) : RYAN RABON, INC.
Provider Business Mailing Address
First Line : 760 PAULDING PLZ
Second Line :
City : DALLAS
State : GA
Zip : 30132-5028
Country : US
Telephone Number : 770-445-6422
Fax Number : 770-443-0180
Provider Business Practice Location Address
First Line : 760 PAULDING PLZ
Second Line :
City : DALLAS
State : GA
Zip : 30132-5028
Country : US
Telephone Number : 770-445-6422
Fax Number : 770-443-0180
Authorized Official
Title or Position : OWNER PHARMACIST
Name : MICHAEL O'NEAL MARTIN
Credential : RPH
Telephone Number : 770-445-6422
Provider Enumeration Date : 12/22/2006
Last Update Date : 03/07/2023

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