Healthcare Provider Details

I. General information

NPI: 1336231109
Provider Name (Legal Business Name): TRICIA RONK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S SIDE SHOPPING CTR
CHILTON WI
53014-1615
US

IV. Provider business mailing address

102 S SIDE SHOPPING CTR
CHILTON WI
53014-1615
US

V. Phone/Fax

Practice location:
  • Phone: 920-849-9313
  • Fax: 920-849-4062
Mailing address:
  • Phone: 920-849-9313
  • Fax: 920-849-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12797-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: