Provider Demographics
NPI:1053679191
Name:VANSANT, RICHARD LEE SR (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:VANSANT
Suffix:SR
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 1:7125 GRASSMOOR GRANGE WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6509
Mailing Address - Country:US
Mailing Address - Phone:770-889-1050
Mailing Address - Fax:
Practice Address - Street 1:7125 GRASSMOOR GRANGE WAY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6509
Practice Address - Country:US
Practice Address - Phone:770-889-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist