Provider Demographics
NPI:1568644839
Name:PELHAM, RONALD W (RCPH)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:W
Last Name:PELHAM
Suffix:
Gender:M
Credentials:RCPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16555 NW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6583
Mailing Address - Country:US
Mailing Address - Phone:786-466-1625
Mailing Address - Fax:786-466-1754
Practice Address - Street 1:16555 NW 25TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-6583
Practice Address - Country:US
Practice Address - Phone:786-466-1625
Practice Address - Fax:786-466-1754
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU3188183500000X
FL176571835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist