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General NPI Number Information
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NPI Number | 1528304565
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Entity Type | Individual
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Provider Name | ERIC R CONGDON RPH
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Gender | Male
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 5918 STONERIDGE MALL RD
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City | PLEASANTON
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State | CA
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Zip | 94588-3229
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Country | US
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Telephone | 925-469-7692
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Fax | 877-466-8040
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Provider Business Mailing Address
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Address Line | 436 MADRONE AVE
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City | LARKSPUR
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State | CA
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Zip | 94939-1917
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Country | US
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Telephone | 925-519-4316
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Fax | 877-466-8040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 41619
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License Number State | CA
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