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MR. DECLAN GERARD PRENDERGAST

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1881995041

Individual Registrant:
MR. DECLAN GERARD PRENDERGAST 
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

Contact information for business:
16405 RIVER RD.  GUERNEVILLE, CA 95446 US
Tel: 707-869-0613  Fax: 707-869-1945

Registration Information:
NPI: 1881995041
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
CA43386

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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