Provider Demographics
NPI:1053607978
Name:LAGRONE, RONNIE WAYNE
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:WAYNE
Last Name:LAGRONE
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 1:2810 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1032
Mailing Address - Country:US
Mailing Address - Phone:210-927-4752
Mailing Address - Fax:210-927-4752
Practice Address - Street 1:2810 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1032
Practice Address - Country:US
Practice Address - Phone:210-927-4752
Practice Address - Fax:210-927-4752
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist