Provider Demographics
NPI:1235628728
Name:SELNESS, RONALD (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SELNESS
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 1:5442 DEHESA RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1816
Mailing Address - Country:US
Mailing Address - Phone:619-445-3518
Mailing Address - Fax:
Practice Address - Street 1:5442 SYCUAN RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1816
Practice Address - Country:US
Practice Address - Phone:619-445-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25113333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy