Provider Demographics
NPI:1750834834
Name:BORNAKO, RICHARD LOUIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LOUIS
Last Name:BORNAKO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5519
Mailing Address - Country:US
Mailing Address - Phone:215-629-5690
Mailing Address - Fax:
Practice Address - Street 1:1101 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5519
Practice Address - Country:US
Practice Address - Phone:215-629-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist