Provider Demographics
NPI:1770806069
Name:RONK, CLYDE H (RPH)
Entity type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:H
Last Name:RONK
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 1:34 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4120
Mailing Address - Country:US
Mailing Address - Phone:518-587-3098
Mailing Address - Fax:518-587-4925
Practice Address - Street 1:34 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4120
Practice Address - Country:US
Practice Address - Phone:518-587-3098
Practice Address - Fax:518-587-4925
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist