Provider Demographics
NPI:1093327397
Name:RICHARDSON, PETER PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:PAUL
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 1:4313 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4823
Mailing Address - Country:US
Mailing Address - Phone:432-699-8011
Mailing Address - Fax:432-699-8126
Practice Address - Street 1:4313 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4823
Practice Address - Country:US
Practice Address - Phone:432-699-8011
Practice Address - Fax:432-699-8126
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist