Provider Demographics
NPI:1235470113
Name:KILLIAN, RONALD JOSEPH
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOSEPH
Last Name:KILLIAN
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 1:3701 LAPEER RD
Mailing Address - Street 2:T-629
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-4598
Mailing Address - Country:US
Mailing Address - Phone:810-743-6380
Mailing Address - Fax:
Practice Address - Street 1:3701 LAPEER RD
Practice Address - Street 2:T-629
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-4598
Practice Address - Country:US
Practice Address - Phone:810-743-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist