Provider Demographics
NPI:1104823533
Name:RONCO PHARMACY, INC.
Entity Type:Organization
Organization Name:RONCO PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:RONCO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-678-1119
Mailing Address - Street 1:3311 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1436
Mailing Address - Country:US
Mailing Address - Phone:610-678-1119
Mailing Address - Fax:610-678-8470
Practice Address - Street 1:3311 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1436
Practice Address - Country:US
Practice Address - Phone:610-678-1119
Practice Address - Fax:610-678-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP22485L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0849940001Medicare NSC