Provider Demographics
NPI:1346574613
Name:PURCELL, RICHARD KEVIN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KEVIN
Last Name:PURCELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SAINT DENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5253
Mailing Address - Country:US
Mailing Address - Phone:361-443-4825
Mailing Address - Fax:
Practice Address - Street 1:135 SAINT DENNIS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5253
Practice Address - Country:US
Practice Address - Phone:361-443-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist