Provider Demographics
NPI:1235153180
Name:RICHARDSON, KENT A (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:A
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 1:7061 MARK TWAIN DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-4119
Mailing Address - Country:US
Mailing Address - Phone:316-788-0334
Mailing Address - Fax:
Practice Address - Street 1:3510 N RIDGE RD
Practice Address - Street 2:SUITE 900
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1224
Practice Address - Country:US
Practice Address - Phone:316-773-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist