Provider Demographics
NPI:1912319948
Name:BURRAGE, RONDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:BURRAGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2304
Mailing Address - Country:US
Mailing Address - Phone:707-765-9100
Mailing Address - Fax:707-789-0472
Practice Address - Street 1:157 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2304
Practice Address - Country:US
Practice Address - Phone:707-765-9100
Practice Address - Fax:707-789-0472
Is Sole Proprietor?:No
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50343OtherPHARMACIST LICENSE