Provider Demographics
NPI:1780930404
Name:SOMERA, IDA RAGOJO (RPH)
Entity type:Individual
Prefix:MISS
First Name:IDA
Middle Name:RAGOJO
Last Name:SOMERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 N EL DORADO ST
Mailing Address - Street 2:APT 154
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-478-1598
Mailing Address - Fax:
Practice Address - Street 1:4774 WEST LANE
Practice Address - Street 2:APT 154
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210
Practice Address - Country:US
Practice Address - Phone:209-473-9170
Practice Address - Fax:209-473-9174
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist