Provider Demographics
NPI:1528395910
Name:BOARDMAN, RICHARD EARLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EARLE
Last Name:BOARDMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-7760
Mailing Address - Country:US
Mailing Address - Phone:817-594-7114
Mailing Address - Fax:
Practice Address - Street 1:130 N OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-7760
Practice Address - Country:US
Practice Address - Phone:817-594-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist