Provider Demographics
NPI:1447633003
Name:MALDONADO, FERNANDO III (PHARM D)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:MALDONADO
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308-B TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004
Mailing Address - Country:US
Mailing Address - Phone:805-647-1133
Mailing Address - Fax:805-647-4076
Practice Address - Street 1:9308-B TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004
Practice Address - Country:US
Practice Address - Phone:805-647-1133
Practice Address - Fax:805-647-4076
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist