Provider Demographics
NPI:1215409792
Name:PELLETIER, RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PELLETIER
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 1:2105 ACADEMY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5829
Mailing Address - Country:US
Mailing Address - Phone:804-376-7168
Mailing Address - Fax:804-376-7982
Practice Address - Street 1:2105 ACADEMY RD STE 2
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5829
Practice Address - Country:US
Practice Address - Phone:804-376-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist