Provider Demographics
NPI:1508823501
Name:SONNTAG, RUBY MAY (PHARM D)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:MAY
Last Name:SONNTAG
Suffix:
Gender:F
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 1:3746 W BENJAMIN HOLT DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3324
Mailing Address - Country:US
Mailing Address - Phone:209-477-5644
Mailing Address - Fax:
Practice Address - Street 1:7506 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-1929
Practice Address - Country:US
Practice Address - Phone:209-951-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18262171100000X
CA41503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171100000XOther Service ProvidersAcupuncturist