Provider Demographics
NPI:1174106678
Name:VILLENA, FERDINAND (PHARMD)
Entity type:Individual
Prefix:
First Name:FERDINAND
Middle Name:
Last Name:VILLENA
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 1:7935 CONKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4107
Mailing Address - Country:US
Mailing Address - Phone:562-879-2846
Mailing Address - Fax:
Practice Address - Street 1:184 E LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1011
Practice Address - Country:US
Practice Address - Phone:714-220-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist