Provider Demographics
NPI:1083215545
Name:RICHARDSON, ALICIA K (PHARMD, BSPS, RPH)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:K
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHARMD, BSPS, RPH
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:K
Other - Last Name:RAUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BSPS, RPH
Mailing Address - Street 1:15629 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-6702
Mailing Address - Country:US
Mailing Address - Phone:419-591-8449
Mailing Address - Fax:
Practice Address - Street 1:485 AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-8709
Practice Address - Country:US
Practice Address - Phone:419-337-8122
Practice Address - Fax:419-337-8492
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03234202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist