Provider Demographics
NPI:1740634468
Name:TAMAYO, RON ARLEIGH
Entity type:Individual
Prefix:
First Name:RON ARLEIGH
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W MARINE DR
Mailing Address - Street 2:APT 99
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5642
Mailing Address - Country:US
Mailing Address - Phone:808-258-9301
Mailing Address - Fax:
Practice Address - Street 1:145 US-101
Practice Address - Street 2:ATTN: RITE AID
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-861-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist