Provider Demographics
NPI:1497768253
Name:YAWN, RICHMOND WESLEY (RPH)
Entity Type:Individual
Prefix:
First Name:RICHMOND
Middle Name:WESLEY
Last Name:YAWN
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 1:1641 CLEARVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-3230
Mailing Address - Country:US
Mailing Address - Phone:601-736-4773
Mailing Address - Fax:601-736-4773
Practice Address - Street 1:1201 HIGHWAY 13 N
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-2015
Practice Address - Country:US
Practice Address - Phone:601-736-1514
Practice Address - Fax:601-736-1514
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-05802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist