Provider Demographics
NPI:1750506002
Name:RICCIARDI, SANDY (RPH)
Entity Type:Individual
Prefix:MR
First Name:SANDY
Middle Name:
Last Name:RICCIARDI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8095 SHANNON GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8557
Mailing Address - Country:US
Mailing Address - Phone:614-873-2905
Mailing Address - Fax:
Practice Address - Street 1:200 HOFF RD
Practice Address - Street 2:SUITE A
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7153
Practice Address - Country:US
Practice Address - Phone:866-507-4276
Practice Address - Fax:866-907-4276
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-18938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist