Provider Demographics
NPI:1457683674
Name:KANIA, RICHARD WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WAYNE
Last Name:KANIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DIVISION ST N
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1150
Mailing Address - Country:US
Mailing Address - Phone:715-341-5613
Mailing Address - Fax:715-341-7880
Practice Address - Street 1:111 DIVISION ST N
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1150
Practice Address - Country:US
Practice Address - Phone:715-341-5613
Practice Address - Fax:715-341-7880
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7647-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist