Healthcare Provider Details

I. General information

NPI: 1013206093
Provider Name (Legal Business Name): RONALD AUGUST SPOLAR B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W F ST
OAKDALE CA
95361-3501
US

IV. Provider business mailing address

1300 W F ST
OAKDALE CA
95361-3501
US

V. Phone/Fax

Practice location:
  • Phone: 209-847-1324
  • Fax:
Mailing address:
  • Phone: 209-847-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25286
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP3499
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: