Provider Demographics
NPI:1407188014
Name:DEMARIA, RONALD ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ANTHONY
Last Name:DEMARIA
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 1:17550 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2006
Mailing Address - Country:US
Mailing Address - Phone:708-922-1588
Mailing Address - Fax:708-922-0116
Practice Address - Street 1:17550 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2006
Practice Address - Country:US
Practice Address - Phone:708-922-1588
Practice Address - Fax:708-922-0116
Is Sole Proprietor?:No
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286511183500000X
MI5302031715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist