Provider Demographics
NPI:1649356999
Name:RENGE, MELVIN K (PHD)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:K
Last Name:RENGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 F ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3418
Mailing Address - Country:US
Mailing Address - Phone:559-264-2808
Mailing Address - Fax:559-264-1852
Practice Address - Street 1:833 F ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3418
Practice Address - Country:US
Practice Address - Phone:559-264-2808
Practice Address - Fax:559-264-1852
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH33277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA219260Medicaid