Provider Demographics
NPI:1467687764
Name:PATTON, RICHARD CARLYLE (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CARLYLE
Last Name:PATTON
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 1:4404 ALTAMA AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3022
Mailing Address - Country:US
Mailing Address - Phone:912-264-5310
Mailing Address - Fax:912-264-6910
Practice Address - Street 1:23106 US 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1849
Practice Address - Country:US
Practice Address - Phone:727-724-3403
Practice Address - Fax:727-791-6363
Is Sole Proprietor?:No
Enumeration Date:2009-05-16
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48504183500000X
GARPH013398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist