Provider Demographics
NPI:1265714810
Name:MUNDZIAK, RONALD (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MUNDZIAK
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 1:5555 NEW ALBANY RD E
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7017
Mailing Address - Country:US
Mailing Address - Phone:614-855-4806
Mailing Address - Fax:614-855-5143
Practice Address - Street 1:5555 NEW ALBANY RD E
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7017
Practice Address - Country:US
Practice Address - Phone:614-855-4806
Practice Address - Fax:614-855-5143
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-16337183500000X
WV4040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist