Provider Demographics
NPI:1558331322
Name:GENDRON, RICHARD TIMOTHY (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TIMOTHY
Last Name:GENDRON
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 1:8 ROBERTS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1026
Mailing Address - Country:US
Mailing Address - Phone:757-271-6378
Mailing Address - Fax:757-953-0863
Practice Address - Street 1:620 JHN PAUL JNS CIR
Practice Address - Street 2:NAVAL MEDICAL CENTER PHARMACY DEPARTMENT
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-0252
Practice Address - Fax:757-953-0863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist