Healthcare Provider Details

I. General information

NPI: 1427343342
Provider Name (Legal Business Name): ROUAN EDWIN KRUGER PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 CRESTON RD WILLIAMS PLAZA
PASO ROBLES CA
93446
US

IV. Provider business mailing address

1156 CRESTON RD WILLIAMS PLAZA
PASO ROBLES CA
93446
US

V. Phone/Fax

Practice location:
  • Phone: 805-239-3028
  • Fax:
Mailing address:
  • Phone: 805-239-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: