Provider Demographics
NPI:1699598060
Name:ABANIEL, RICHARD MATTHEW (PHARMD)
Entity type:Individual
Prefix:
First Name:RICHARD MATTHEW
Middle Name:
Last Name:ABANIEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 BLUE HERON
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5612
Mailing Address - Country:US
Mailing Address - Phone:714-876-7969
Mailing Address - Fax:
Practice Address - Street 1:944 BLUE HERON
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5612
Practice Address - Country:US
Practice Address - Phone:714-876-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist