Provider Demographics
NPI:1083056832
Name:LORANG, MARVIN KEITH (RPH)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:KEITH
Last Name:LORANG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 GRAY LODGE CT
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-9624
Mailing Address - Country:US
Mailing Address - Phone:559-859-7122
Mailing Address - Fax:
Practice Address - Street 1:1955 GRAY LODGE CT
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-9624
Practice Address - Country:US
Practice Address - Phone:559-859-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist