1114212644 NPI number — MR. PATRICK BYRON RENFRO PHARMD

Table of content: MR. PATRICK BYRON RENFRO PHARMD (NPI 1114212644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114212644 NPI number — MR. PATRICK BYRON RENFRO PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENFRO
Provider First Name:
PATRICK
Provider Middle Name:
BYRON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114212644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 MALL VIEW RD
Provider Second Line Business Mailing Address:
T-0614
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93306-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-872-5843
Provider Business Mailing Address Fax Number:
661-872-5843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 MALL VIEW RD
Provider Second Line Business Practice Location Address:
T-0614
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93306-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-872-5843
Provider Business Practice Location Address Fax Number:
661-872-5843
Provider Enumeration Date:
06/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH 36594 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com