=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427069012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONS APOTHECARY SHOP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 02/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117A W RENFRO
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-295-2273
-----------------------------------------------------
Fax | 817-295-8827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117A W RENFRO
-----------------------------------------------------
City | BURLESON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-295-2273
-----------------------------------------------------
Fax | 817-295-8827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MATT GIESER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-295-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 22327
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------