Provider Demographics
NPI:1073501144
Name:RONCI FAMILY DISCOUNT DRUG
Entity Type:Organization
Organization Name:RONCI FAMILY DISCOUNT DRUG
Other - Org Name:MARTYS FAMILY DISCOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:RONCI
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-792-7808
Mailing Address - Street 1:2249 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920
Mailing Address - Country:US
Mailing Address - Phone:330-386-5521
Mailing Address - Fax:330-386-0508
Practice Address - Street 1:2249 LISBON ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920
Practice Address - Country:US
Practice Address - Phone:330-386-5521
Practice Address - Fax:330-386-0508
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONCI FAMILY DISCOUNT DRUG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-12
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0206730003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0842799Medicaid
OH0842799Medicaid