Robert Carl Ault, RPH
Individual provider Active NPI Pharmacist · Dalton, GA
NPI 1508133141 · NPPES record last updated Nov 28, 2011
Key facts
- NPI
- 1508133141
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 012519 (GA)
- Practice address
- 1308 W Walnut Ave
Dalton, GA 30720-3827 - Phone
- (706) 618-2130
- NPI assigned
- Nov 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012519 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 012519 | GA | Yes |
Addresses
Primary practice location
1308 W Walnut Ave
Dalton, GA 30720-3827
Mailing address
214 N Varnell Rd
Tunnel Hill, GA 30755-9219
Phone (706) 673-2001
Other providers in Dalton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.