Provider Demographics
NPI:1619008984
Name:LATTANZIO, RONALD J SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:LATTANZIO
Suffix:SR
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 1:1410 MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1529
Mailing Address - Country:US
Mailing Address - Phone:814-255-1120
Mailing Address - Fax:
Practice Address - Street 1:552 LOCUST ST.
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:PA
Practice Address - Zip Code:15951-0306
Practice Address - Country:US
Practice Address - Phone:814-495-9437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033622L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP033622LOtherPHARMACIST LICENSE