Provider Demographics
NPI:1003955394
Name:RONTIRIS, GEORGE C (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:C
Last Name:RONTIRIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6246
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-0246
Mailing Address - Country:US
Mailing Address - Phone:718-267-8063
Mailing Address - Fax:
Practice Address - Street 1:3519 31ST AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-1408
Practice Address - Country:US
Practice Address - Phone:718-267-8063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042377OtherNY STATE PHARMACY LICENSE