MEDICARE: MR. RONALD POLING R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	03110917	OH

General Provider Information

NPI Number	:	1255742318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD POLING R.PH.

Provider Business Mailing Address
First Line	:	830 WESTLAKE DR
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-8756
Country	:	US
Telephone Number	:	937-339-4733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 W MAIN ST
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1017
Country	:	US
Telephone Number	:	937-335-1811
Fax Number	:	937-332-0565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	05/12/2014

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Directions to “ MR. RONALD POLING R.PH.” Practice Location

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