Healthcare Provider Details

I. General information

NPI: 1649899105
Provider Name (Legal Business Name): RONNIE JAMES DELMONTE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

1841 HERITAGE LN
PALMDALE CA
93551-4092
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-3653
  • Fax:
Mailing address:
  • Phone: 661-903-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number74914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: