Provider Demographics
NPI:1821333980
Name:RONNGREN, JEFFREY J (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:RONNGREN
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 1:16902 E 27TH LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8763
Mailing Address - Country:US
Mailing Address - Phone:509-290-1146
Mailing Address - Fax:
Practice Address - Street 1:16902 E 27TH LN
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:WA
Practice Address - Zip Code:99016-8763
Practice Address - Country:US
Practice Address - Phone:509-290-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist