Provider Demographics
NPI:1528208303
Name:BRAIDWOOD, RICHARD K (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:BRAIDWOOD
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 1:2100 N M 76
Mailing Address - Street 2:P.O. BOX 38
Mailing Address - City:SAINT HELEN
Mailing Address - State:MI
Mailing Address - Zip Code:48656-9209
Mailing Address - Country:US
Mailing Address - Phone:989-389-7277
Mailing Address - Fax:989-389-7225
Practice Address - Street 1:2206 S. M-76
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661
Practice Address - Country:US
Practice Address - Phone:989-345-5610
Practice Address - Fax:989-345-7987
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist