Provider Demographics
NPI:1669531950
Name:MACE, RALPH RICHARD III (R PH)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:RICHARD
Last Name:MACE
Suffix:III
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-1240
Mailing Address - Country:US
Mailing Address - Phone:304-457-4233
Mailing Address - Fax:304-457-6760
Practice Address - Street 1:440 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-1240
Practice Address - Country:US
Practice Address - Phone:304-457-4233
Practice Address - Fax:304-457-6760
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13962183500000X
WV5930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5930OtherSTATE LICENSE