Active NPI
Pryde Manga Fonbah, RPH
- Pharmacist
- Ukiah, CA
National Provider Identifier
1922239623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 47835
- Practice address
- 155 S. Orchard Ave
Ukiah, CA 95182 - Phone
- (707) 462-9751
- NPI assigned
- Jul 29, 2009
- Reactivated
- May 13, 2015
- Last updated
- Feb 23, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 47835 | CA | Primary |
Addresses
Primary practice location
155 S. Orchard Ave
Ukiah, CA 95182
Mailing address
2740 Jordan Ave
Clovis, CA 93611-8178
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47835 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456185600000",
"number": "1922239623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2740 JORDAN AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936118178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 S. ORCHARD AVE",
"city": "UKIAH",
"state": "CA",
"postal_code": "95182",
"telephone_number": "707-462-9751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONBAH",
"first_name": "PRYDE",
"middle_name": "MANGA",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-29",
"last_updated": "2016-02-23",
"deactivation_date": "2014-11-18",
"reactivation_date": "2015-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "47835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.