Provider Demographics
NPI:1053666032
Name:KIKUCHI, CRAIG LEO (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:LEO
Last Name:KIKUCHI
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 1:1335 S BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-481-8711
Mailing Address - Fax:805-922-9367
Practice Address - Street 1:1700 S BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8001
Practice Address - Country:US
Practice Address - Phone:805-922-3430
Practice Address - Fax:805-922-9367
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52218183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist