Provider Demographics
NPI:1437602026
Name:RICHARDSON, ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7476
Mailing Address - Country:US
Mailing Address - Phone:205-522-2683
Mailing Address - Fax:
Practice Address - Street 1:5558 CURRY HWY STE 9
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-5866
Practice Address - Country:US
Practice Address - Phone:205-221-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist