Provider Demographics
NPI:1497392286
Name:RONGAKIS, GEORGIA (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:RONGAKIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 WHEATLANDS RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3554
Mailing Address - Country:US
Mailing Address - Phone:419-351-7374
Mailing Address - Fax:
Practice Address - Street 1:571 E MONROE ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-1309
Practice Address - Country:US
Practice Address - Phone:734-529-7684
Practice Address - Fax:734-529-8184
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist