Provider Demographics
NPI:1700186889
Name:RICKARD, CRAIG EDMOND (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:EDMOND
Last Name:RICKARD
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 1:373 S MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3507
Mailing Address - Country:US
Mailing Address - Phone:707-762-1479
Mailing Address - Fax:707-762-1896
Practice Address - Street 1:373 S MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3507
Practice Address - Country:US
Practice Address - Phone:707-762-1479
Practice Address - Fax:707-762-1896
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL32905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist