MEDICARE: RON'S 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	3336C0003X	Community/Retail Pharmacy	50006716	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4217306	OTHER	SC	NCPDP NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760544894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RON'S PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2212 OLD FURNACE RD
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-5782
Country	:	US
Telephone Number	:	864-599-0889
Fax Number	:	864-599-0824

Provider Business Practice Location Address
First Line	:	2212 OLD FURNACE RD
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-5782
Country	:	US
Telephone Number	:	864-599-0889
Fax Number	:	864-599-0824

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES R GUIDA
Credential	:	RPH
Telephone Number	:	864-599-0889

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	06/17/2008

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