Provider Demographics
NPI:1164730636
Name:WRIGHT, RICHARD L (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:WRIGHT
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 1:203 MCMINN CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-7985
Mailing Address - Country:US
Mailing Address - Phone:662-773-7881
Mailing Address - Fax:662-773-9982
Practice Address - Street 1:502 S CHURCH AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-3102
Practice Address - Country:US
Practice Address - Phone:662-773-8021
Practice Address - Fax:662-773-9982
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist