Basic Information
Provider Information
NPI: 1427425032
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PROPST
FirstName: RONALD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2700 DOLBEER ST
Address2:  
City: EUREKA
State: CA
PostalCode: 955014736
CountryCode: US
TelephoneNumber: 7074458121
FaxNumber: 7072693731
Practice Location
Address1: 2700 DOLBEER ST
Address2:  
City: EUREKA
State: CA
PostalCode: 955014736
CountryCode: US
TelephoneNumber: 7074458121
FaxNumber: 7072693731
Other Information
ProviderEnumerationDate: 08/31/2015
LastUpdateDate: 08/31/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1835X0200X47468CAY Pharmacy Service ProvidersPharmacistOncology

No ID Information.


Home