Provider Demographics
NPI:1043797285
Name:ALTIZER, RICHARD LOGAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOGAN
Last Name:ALTIZER
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 1:7480 BIRDWOOD AVE
Mailing Address - Street 2:APT #416
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102
Mailing Address - Country:US
Mailing Address - Phone:540-309-7984
Mailing Address - Fax:
Practice Address - Street 1:22370 DAVIS DR STE 190
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-5367
Practice Address - Country:US
Practice Address - Phone:703-434-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist