Provider Demographics
NPI:1811047558
Name:OPOLKA, RONNIE E SR (RPH)
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:E
Last Name:OPOLKA
Suffix:SR
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 1:701 HILL AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-1309
Mailing Address - Country:US
Mailing Address - Phone:256-582-0410
Mailing Address - Fax:256-582-6573
Practice Address - Street 1:1445 GUNTER AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1845
Practice Address - Country:US
Practice Address - Phone:256-505-0310
Practice Address - Fax:256-582-6573
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist