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MR. DECLAN GERARD PRENDERGAST
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1881995041
Individual Registrant:MR. DECLAN GERARD PRENDERGAST
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
16405 RIVER RD. GUERNEVILLE, CA 95446 US
Tel: 707-869-0613 Fax: 707-869-1945
Tel: 707-869-0613 Fax: 707-869-1945
Contact information for business:
16405 RIVER RD. GUERNEVILLE, CA 95446 US
Tel: 707-869-0613 Fax: 707-869-1945
Tel: 707-869-0613 Fax: 707-869-1945
Registration Information:
NPI: 1881995041
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | CA | 43386 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
