Healthcare Provider Details

I. General information

NPI: 1417587825
Provider Name (Legal Business Name): RONNY ZETTS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RONNY K ZETTS PHARMACIST

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BOARDMAN-CANFIELD RD
BOARDMAN OH
44512
US

IV. Provider business mailing address

308 BOARDMAN CANFIELD RD
BORADMAN OH
44512
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-2824
  • Fax: 330-758-1435
Mailing address:
  • Phone: 330-758-2824
  • Fax: 330-758-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03120628
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: