Provider Demographics
NPI:1750722989
Name:SMITH, RONALD KENNETH (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:KENNETH
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 W SENECA ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1546
Mailing Address - Country:US
Mailing Address - Phone:315-591-6749
Mailing Address - Fax:
Practice Address - Street 1:63 W SENECA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-1546
Practice Address - Country:US
Practice Address - Phone:315-591-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist