Provider Demographics
NPI:1508161506
Name:ANDO, RICHARD JIRO (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JIRO
Last Name:ANDO
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 1:397 COLBY CIR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3854
Mailing Address - Country:US
Mailing Address - Phone:805-642-9324
Mailing Address - Fax:805-650-2160
Practice Address - Street 1:6040 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4372
Practice Address - Country:US
Practice Address - Phone:805-650-2155
Practice Address - Fax:805-650-2160
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27243183500000X
NV05724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist