Provider Demographics
NPI:1982479978
Name:CLINTON, RONALD K (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:K
Last Name:CLINTON
Suffix:
Gender:M
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:PO BOX 2091
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90231-2091
Mailing Address - Country:US
Mailing Address - Phone:310-738-3199
Mailing Address - Fax:
Practice Address - Street 1:11700 NATIONAL BLVD STE L
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3668
Practice Address - Country:US
Practice Address - Phone:310-738-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist