Provider Demographics
NPI:1033713052
Name:ROZELL, RONNY RAY
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:RAY
Last Name:ROZELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 PATTYS WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6476
Mailing Address - Country:US
Mailing Address - Phone:936-577-6133
Mailing Address - Fax:936-830-3138
Practice Address - Street 1:18275 FM 306
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-3351
Practice Address - Country:US
Practice Address - Phone:830-935-3136
Practice Address - Fax:830-935-3138
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist