Provider Demographics
NPI:1528304565
Name:CONGDON, ERIC R (RPH)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:R
Last Name:CONGDON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 MADRONE AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1917
Mailing Address - Country:US
Mailing Address - Phone:925-519-4316
Mailing Address - Fax:877-466-8040
Practice Address - Street 1:5918 STONERIDGE MALL RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3229
Practice Address - Country:US
Practice Address - Phone:925-469-7692
Practice Address - Fax:877-466-8040
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist