Provider Demographics
NPI:1780967638
Name:VICK, RONDA ANN (RPH)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:ANN
Last Name:VICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 QUAIL CREST DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-7606
Mailing Address - Country:US
Mailing Address - Phone:817-565-4456
Mailing Address - Fax:
Practice Address - Street 1:1317 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5528
Practice Address - Country:US
Practice Address - Phone:817-594-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist