Provider Demographics
NPI:1841557402
Name:CONDE, WILLIAM KENNETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KENNETH
Last Name:CONDE
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 1:3944 GRAND AVE
Mailing Address - Street 2:T-0912
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3944 GRAND AVE
Practice Address - Street 2:T-0912
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5422
Practice Address - Country:US
Practice Address - Phone:909-364-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist