Provider Demographics
NPI:1902327729
Name:PUCKETT, RORY ELI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:ELI
Last Name:PUCKETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 COURAGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7611
Mailing Address - Country:US
Mailing Address - Phone:614-725-7950
Mailing Address - Fax:
Practice Address - Street 1:1365 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8701
Practice Address - Country:US
Practice Address - Phone:614-418-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-01
Last Update Date:2017-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist