Provider Demographics
NPI:1487863643
Name:STORY, RICHARD DALE (BS PHARM MPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DALE
Last Name:STORY
Suffix:
Gender:M
Credentials:BS PHARM MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 TOPEKA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004
Mailing Address - Country:US
Mailing Address - Phone:805-218-8648
Mailing Address - Fax:805-671-5191
Practice Address - Street 1:681 TOPEKA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004
Practice Address - Country:US
Practice Address - Phone:805-218-8648
Practice Address - Fax:805-671-5191
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26828183500000X
LA15746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist