Provider Demographics
NPI:1457638371
Name:RICHARDS, BEVERLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2714
Mailing Address - Country:US
Mailing Address - Phone:773-239-2808
Mailing Address - Fax:773-239-1935
Practice Address - Street 1:3220 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2714
Practice Address - Country:US
Practice Address - Phone:773-239-2808
Practice Address - Fax:773-239-1935
Is Sole Proprietor?:No
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist