Provider Demographics
NPI:1730658519
Name:KUMAR, RAVIKESH RAYNEEL (RPH)
Entity Type:Individual
Prefix:
First Name:RAVIKESH
Middle Name:RAYNEEL
Last Name:KUMAR
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 1:639 RILEY FORD LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6289
Mailing Address - Country:US
Mailing Address - Phone:209-817-6044
Mailing Address - Fax:
Practice Address - Street 1:3010 W GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-9402
Practice Address - Country:US
Practice Address - Phone:209-836-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist