Provider Demographics
NPI:1912012931
Name:RONS APOTHECARY INC
Entity Type:Organization
Organization Name:RONS APOTHECARY INC
Other - Org Name:RON'S APOTHECARY SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:907-789-0458
Mailing Address - Street 1:PO BOX 32007
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2007
Mailing Address - Country:US
Mailing Address - Phone:907-789-0458
Mailing Address - Fax:907-789-1356
Practice Address - Street 1:9101 MENDENHALL MALL RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7113
Practice Address - Country:US
Practice Address - Phone:907-789-0458
Practice Address - Fax:907-789-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
AK3753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1996433OtherPK
AK1028470Medicaid
AKPH0071Medicaid
AKPH0071Medicaid