Healthcare Provider Details

I. General information

NPI: 1104823533
Provider Name (Legal Business Name): RONCO PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PENN AVE
WEST LAWN PA
19609-1436
US

IV. Provider business mailing address

3311 PENN AVE
WEST LAWN PA
19609-1436
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-1119
  • Fax: 610-678-8470
Mailing address:
  • Phone: 610-678-1119
  • Fax: 610-678-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP22485L
License Number StatePA

VIII. Authorized Official

Name: MICHAEL R RONCO
Title or Position: OWNER
Credential: R.PH.
Phone: 610-678-1119