Provider Demographics
NPI:1093037004
Name:RICHARDSON, RORY M (RPH)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:M
Last Name:RICHARDSON
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 1:1445 S POWER RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3705
Mailing Address - Country:US
Mailing Address - Phone:480-985-7623
Mailing Address - Fax:480-807-4203
Practice Address - Street 1:1445 S POWER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3705
Practice Address - Country:US
Practice Address - Phone:480-985-7623
Practice Address - Fax:480-807-4203
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist