Healthcare Provider Details

I. General information

NPI: 1710986484
Provider Name (Legal Business Name): RONALD J. MESSICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 3RD ST
CALIFORNIA PA
15419-1134
US

IV. Provider business mailing address

322 3RD ST
CALIFORNIA PA
15419-1134
US

V. Phone/Fax

Practice location:
  • Phone: 724-938-2395
  • Fax: 724-938-8244
Mailing address:
  • Phone: 724-938-2395
  • Fax: 724-938-8244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number377IVI
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPP413276L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP413276L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413276L
License Number StatePA

VIII. Authorized Official

Name: RONALD J MESSICK
Title or Position: OWNER
Credential:
Phone: 724-938-2395