MEDICARE: CRAIG EDMOND RICKARD PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	L32905	CA

General Provider Information

NPI Number	:	1700186889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG EDMOND RICKARD PHARMD

Provider Business Mailing Address
First Line	:	373 S MCDOWELL BLVD
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-3507
Country	:	US
Telephone Number	:	707-762-1479
Fax Number	:	707-762-1896

Provider Business Practice Location Address
First Line	:	373 S MCDOWELL BLVD
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-3507
Country	:	US
Telephone Number	:	707-762-1479
Fax Number	:	707-762-1896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2010
Last Update Date	:	10/23/2010

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