Provider Demographics
NPI:1093871980
Name:RONALD J KREIN
Entity Type:Organization
Organization Name:RONALD J KREIN
Other - Org Name:VALLEY PRESCRIPTION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KREIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-722-5765
Mailing Address - Street 1:330 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6212
Mailing Address - Country:US
Mailing Address - Phone:209-722-5765
Mailing Address - Fax:209-722-3296
Practice Address - Street 1:330 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6212
Practice Address - Country:US
Practice Address - Phone:209-722-5765
Practice Address - Fax:209-722-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY21708333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA217080Medicaid
0537881OtherOTHER ID NUMBER-COMMERCIAL NUMBER
080949001Medicare ID - Type Unspecified
0537881OtherOTHER ID NUMBER-COMMERCIAL NUMBER