Provider Demographics
NPI:1013902113
Name:RON JENNISON
Entity Type:Organization
Organization Name:RON JENNISON
Other - Org Name:VALU-RITE MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-525-3141
Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:STE 105
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2810
Mailing Address - Country:US
Mailing Address - Phone:209-525-3141
Mailing Address - Fax:209-571-9538
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:STE 105
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-525-3141
Practice Address - Fax:209-571-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA183500000X
CA0859760001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA433230Medicaid
CA4283100001Medicare NSC