Provider Demographics
NPI:1063012474
Name:ROUNDY, RICHARD V (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:V
Last Name:ROUNDY
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 1:1330 S PROVIDENCE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3956
Mailing Address - Country:US
Mailing Address - Phone:435-586-0155
Mailing Address - Fax:435-586-2017
Practice Address - Street 1:1330 S PROVIDENCE CENTER DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3956
Practice Address - Country:US
Practice Address - Phone:435-586-0155
Practice Address - Fax:435-586-2017
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT132774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist