Provider Demographics
NPI:1396044939
Name:RICHARDSON, CASSANDRA T (RPH)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:T
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 MACKAY RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9398
Mailing Address - Country:US
Mailing Address - Phone:336-292-1111
Mailing Address - Fax:336-292-8088
Practice Address - Street 1:5005 MACKAY RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9398
Practice Address - Country:US
Practice Address - Phone:336-292-1111
Practice Address - Fax:336-292-8088
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist