Provider Demographics
NPI:1376306811
Name:RICHARD, SIERRA DAWN (PHARMD, BCPPS)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:DAWN
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PHARMD, BCPPS
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:DAWN
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 W BROADWAY
Mailing Address - Street 2:SUITE 103, PMB 170
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3760
Practice Address - Country:US
Practice Address - Phone:573-714-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019025996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019025996OtherMISSOURI BOARD OF PHARMACY
8151679OtherBOARD OF PHARMACY SPECIALTIES