Active NPI
Ricky Allen McIntyre, RPH
- Pharmacist
- Vidalia, GA
National Provider Identifier
1295089126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH014504
- Practice address
- 1527 Orange St
Vidalia, GA 30474-5916 - Phone
- (912) 245-1810
- Fax
- (912) 537-8709
- NPI assigned
- Oct 30, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH014504 | GA | Primary |
Addresses
Primary practice location
1527 Orange St
Vidalia, GA 30474-5916
Mailing address
PO Box 622
Vidalia, GA 30475-0622
Phone (912) 245-1810
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH014504 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351555200000",
"number": "1295089126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 622",
"city": "VIDALIA",
"state": "GA",
"postal_code": "304750622",
"telephone_number": "912-245-1810",
"fax_number": "912-537-8709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1527 ORANGE ST",
"city": "VIDALIA",
"state": "GA",
"postal_code": "304745916",
"telephone_number": "912-245-1810",
"fax_number": "912-537-8709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCINTYRE",
"first_name": "RICKY",
"middle_name": "ALLEN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-30",
"last_updated": "2012-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH014504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vidalia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.