Provider Demographics
NPI:1225725682
Name:RICHARDSON, MAIA
Entity Type:Individual
Prefix:
First Name:MAIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EDINBOROUGH DR.
Mailing Address - Street 2:APT. 816
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703
Mailing Address - Country:US
Mailing Address - Phone:919-717-6836
Mailing Address - Fax:
Practice Address - Street 1:816 EDINBOROUGH DR APT 816
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8497
Practice Address - Country:US
Practice Address - Phone:919-717-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30037014333600000X, 183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No333600000XSuppliersPharmacy