Provider Demographics
NPI:1518166867
Name:GIESEN, RONALD J (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:GIESEN
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 1:615 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:KS
Mailing Address - Zip Code:67058-1214
Mailing Address - Country:US
Mailing Address - Phone:620-845-0458
Mailing Address - Fax:
Practice Address - Street 1:615 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HARPER
Practice Address - State:KS
Practice Address - Zip Code:67058-1214
Practice Address - Country:US
Practice Address - Phone:620-845-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10973OtherPHARMACY LIC #