Provider Demographics
NPI:1770861163
Name:CLOYD, RON W (RPH)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:W
Last Name:CLOYD
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 1:1271 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-6315
Mailing Address - Country:US
Mailing Address - Phone:951-654-4221
Mailing Address - Fax:951-654-4466
Practice Address - Street 1:1271 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-6315
Practice Address - Country:US
Practice Address - Phone:951-654-4221
Practice Address - Fax:951-654-4466
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist