Provider Demographics
NPI:1609226653
Name:ASIDO, THOMAS RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RYAN
Last Name:ASIDO
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 1:8680 N GLENN AVE
Mailing Address - Street 2:APT 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6936
Mailing Address - Country:US
Mailing Address - Phone:310-408-8087
Mailing Address - Fax:
Practice Address - Street 1:4910 E ASHLAN AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3020
Practice Address - Country:US
Practice Address - Phone:310-408-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist