Provider Demographics
NPI:1376579441
Name:CROMER, RONNIE W (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:W
Last Name:CROMER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EDGEWATER COURT
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29108
Mailing Address - Country:US
Mailing Address - Phone:803-364-3950
Mailing Address - Fax:
Practice Address - Street 1:1254 WILSON RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-4008
Practice Address - Country:US
Practice Address - Phone:803-276-0990
Practice Address - Fax:803-276-4276
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC004265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist