Provider Demographics
NPI:1164564183
Name:MAYNARD, RICHARD HAROLD (DPH)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HAROLD
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 BECKWITH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4820
Mailing Address - Country:US
Mailing Address - Phone:615-754-6221
Mailing Address - Fax:615-754-6221
Practice Address - Street 1:333 N LOWRY ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2550
Practice Address - Country:US
Practice Address - Phone:615-459-8136
Practice Address - Fax:615-355-8306
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist