Provider Demographics
NPI:1821124421
Name:STEVROS INC
Entity Type:Organization
Organization Name:STEVROS INC
Other - Org Name:RANCHO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:559-592-5222
Mailing Address - Street 1:426 N KAWEAH AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1224
Mailing Address - Country:US
Mailing Address - Phone:559-592-5222
Mailing Address - Fax:559-592-3030
Practice Address - Street 1:426 N KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1224
Practice Address - Country:US
Practice Address - Phone:559-592-5222
Practice Address - Fax:559-592-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY429103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA429410Medicaid
CA0574803OtherNCPDP NUMBER
CA0574803OtherNCPDP NUMBER