Provider Demographics
NPI:1356717664
Name:KONDO, LINETTE MIDORI (PHARMD)
Entity type:Individual
Prefix:
First Name:LINETTE
Middle Name:MIDORI
Last Name:KONDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N CLOVIS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0303
Mailing Address - Country:US
Mailing Address - Phone:559-374-2861
Mailing Address - Fax:
Practice Address - Street 1:120 N CLOVIS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0303
Practice Address - Country:US
Practice Address - Phone:559-374-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513891835P0018X
WAPH000416281835P0018X
NV169141835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist