Provider Demographics
NPI:1427343342
Name:KRUGER, ROUAN EDWIN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:ROUAN
Middle Name:EDWIN
Last Name:KRUGER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 CRESTON RD
Mailing Address - Street 2:WILLIAMS PLAZA
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446
Mailing Address - Country:US
Mailing Address - Phone:805-239-3028
Mailing Address - Fax:
Practice Address - Street 1:1156 CRESTON RD
Practice Address - Street 2:WILLIAMS PLAZA
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446
Practice Address - Country:US
Practice Address - Phone:805-239-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist