Provider Demographics
NPI:1396754891
Name:RENGE PHARMACY
Entity type:Organization
Organization Name:RENGE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:RENGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:559-264-2808
Mailing Address - Street 1:833 F ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3418
Mailing Address - Country:US
Mailing Address - Phone:559-264-2808
Mailing Address - Fax:559-264-1852
Practice Address - Street 1:833 F ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3418
Practice Address - Country:US
Practice Address - Phone:559-264-2808
Practice Address - Fax:559-264-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 33277183500000X
CAPHY21926332B00000X, 333600000X
CAPHY 219263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR 1471933OtherD E A LICENCE
CARPH 33277OtherSTATE PHARMACIST LICENCE
CAPHY 21926OtherSTATE PHARMACY LICENCE
1396754891OtherNPI
CAPHA 219260Medicaid
1396754891OtherNPI