Provider Demographics
NPI:1235550203
Name:RONDUEN, ENOCH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ENOCH
Middle Name:
Last Name:RONDUEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8137 MARSHA LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3290
Mailing Address - Country:US
Mailing Address - Phone:808-387-5877
Mailing Address - Fax:
Practice Address - Street 1:18600 EAGLE RIVER RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8688
Practice Address - Country:US
Practice Address - Phone:907-694-9786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist