Healthcare Provider Details

I. General information

NPI: 1952632812
Provider Name (Legal Business Name): DEON PRETORIUS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 CORTE MADERA TOWN CTR
CORTE MADERA CA
94925-1215
US

IV. Provider business mailing address

4460 REDWOOD HWY SUITE 16-352
SAN RAFAEL CA
94903-1951
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-4557
  • Fax:
Mailing address:
  • Phone: 415-924-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: