Provider Demographics
NPI:1376844779
Name:ENGBERSON, RONALD HENRY (PHARM-D)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:HENRY
Last Name:ENGBERSON
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E SEGO LILY DR APT 105
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4260
Mailing Address - Country:US
Mailing Address - Phone:907-250-4933
Mailing Address - Fax:
Practice Address - Street 1:2100 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2224
Practice Address - Country:US
Practice Address - Phone:702-474-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1778183500000X
NV19482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist