MEDICARE: RONCO PHARMACY, 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
1	183500000X	Pharmacist	RP22485L	PA

General Provider Information

NPI Number	:	1104823533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONCO PHARMACY, INC.

Provider Business Mailing Address
First Line	:	3311 PENN AVE
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1436
Country	:	US
Telephone Number	:	610-678-1119
Fax Number	:	610-678-8470

Provider Business Practice Location Address
First Line	:	3311 PENN AVE
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1436
Country	:	US
Telephone Number	:	610-678-1119
Fax Number	:	610-678-8470

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL R RONCO
Credential	:	R.PH.
Telephone Number	:	610-678-1119

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/28/2010

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