Provider Demographics
NPI:1083138069
Name:RICHARDSON, JOHN ERIK I (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ERIK
Last Name:RICHARDSON
Suffix:I
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 1:208 N 41ST ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1290
Mailing Address - Country:US
Mailing Address - Phone:360-500-3798
Mailing Address - Fax:
Practice Address - Street 1:2519 MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1605
Practice Address - Country:US
Practice Address - Phone:509-453-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60748106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist