Provider Demographics
NPI:1457659476
Name:RICHARDSON, WILLIAM BENJAMIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:BENJAMIN
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:9001 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5834
Mailing Address - Country:US
Mailing Address - Phone:803-419-3664
Mailing Address - Fax:
Practice Address - Street 1:9001 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5834
Practice Address - Country:US
Practice Address - Phone:803-419-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist