MEDICARE: MR. RONALD KEVIN PATRICK RPH, MBA

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	1835G0303X	Geriatric Pharmacist	32060	TX

General Provider Information

NPI Number	:	1417074543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD KEVIN PATRICK RPH, MBA

Provider Business Mailing Address
First Line	:	709 GREGORY ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5414
Country	:	US
Telephone Number	:	972-278-3944
Fax Number	:

Provider Business Practice Location Address
First Line	:	7310 S WESTMORELAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2998
Country	:	US
Telephone Number	:	972-709-3594
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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