Provider Demographics
NPI:1922638774
Name:ISHIKAWA, LIONEL VENTUS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:VENTUS
Last Name:ISHIKAWA
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 1:330 BON AIR CTR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-3017
Mailing Address - Country:US
Mailing Address - Phone:415-461-9093
Mailing Address - Fax:
Practice Address - Street 1:330 BON AIR CTR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-3017
Practice Address - Country:US
Practice Address - Phone:415-461-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81913183500000X
FL57990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist