Healthcare Provider Details

I. General information

NPI: 1477875771
Provider Name (Legal Business Name): RONALD D VREDENBURG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2010
Last Update Date: 02/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 US HIGHWAY 23 S
ALPENA MI
49707-4553
US

IV. Provider business mailing address

11539 SAMPSON RD
OSSINEKE MI
49766-9758
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-8418
  • Fax:
Mailing address:
  • Phone: 989-471-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302026056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: