Provider Demographics
NPI:1831871912
Name:TRAEGER, RONALD
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:TRAEGER
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 1:219 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1160
Mailing Address - Country:US
Mailing Address - Phone:570-604-4954
Mailing Address - Fax:
Practice Address - Street 1:1 GREAT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18706-5324
Practice Address - Country:US
Practice Address - Phone:570-820-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist