Provider Demographics
NPI:1669954665
Name:DAVISON, RONALD JR (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:DAVISON
Suffix:JR
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 1:1571 W VILLARD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4656
Mailing Address - Country:US
Mailing Address - Phone:701-227-8265
Mailing Address - Fax:
Practice Address - Street 1:1571 W VILLARD ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4653
Practice Address - Country:US
Practice Address - Phone:701-227-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist