Provider Demographics
NPI:1447279294
Name:MESSICK, RONALD J
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:MESSICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419-1134
Mailing Address - Country:US
Mailing Address - Phone:724-938-2395
Mailing Address - Fax:724-938-8244
Practice Address - Street 1:322 3RD ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1134
Practice Address - Country:US
Practice Address - Phone:724-938-2395
Practice Address - Fax:724-938-8244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032797L183500000X
PAPP413276L333600000X, 3336C0003X
PAJFYUMUXFJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011188830001Medicaid
PA0011188830001Medicaid