Provider Demographics
NPI:1952632812
Name:PRETORIUS, DEON (RPH)
Entity Type:Individual
Prefix:
First Name:DEON
Middle Name:
Last Name:PRETORIUS
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 1:4460 REDWOOD HWY
Mailing Address - Street 2:SUITE 16-352
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1951
Mailing Address - Country:US
Mailing Address - Phone:415-924-4557
Mailing Address - Fax:
Practice Address - Street 1:431 CORTE MADERA TOWN CTR
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1215
Practice Address - Country:US
Practice Address - Phone:415-924-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist