Provider Demographics
NPI:1043505845
Name:VELASCO, RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:VELASCO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N VENTU PARK RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2709
Mailing Address - Country:US
Mailing Address - Phone:805-375-4052
Mailing Address - Fax:805-376-2785
Practice Address - Street 1:550 N VENTU PARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-2709
Practice Address - Country:US
Practice Address - Phone:805-375-4052
Practice Address - Fax:805-376-2785
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03221300183500000X
CA63705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist