Provider Demographics
NPI:1013566983
Name:HALALAY, RONALD VIOREL (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:VIOREL
Last Name:HALALAY
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 1:9190 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2032
Mailing Address - Country:US
Mailing Address - Phone:248-698-9680
Mailing Address - Fax:248-698-9709
Practice Address - Street 1:9190 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-2032
Practice Address - Country:US
Practice Address - Phone:248-698-9680
Practice Address - Fax:248-698-9709
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315170590OtherPHARMACIST CONTROLLED SUBSTANCE LICENSE