Provider Demographics
NPI:1558577890
Name:RICHARDS, JANEEN MICHELE (RPH)
Entity Type:Individual
Prefix:
First Name:JANEEN
Middle Name:MICHELE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4097 ESSEX MILL RD
Mailing Address - Street 2:
Mailing Address - City:DUNNSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22454-2345
Mailing Address - Country:US
Mailing Address - Phone:917-697-4415
Mailing Address - Fax:
Practice Address - Street 1:17422 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435-6230
Practice Address - Country:US
Practice Address - Phone:804-529-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0401281183500000X
VA0202213214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02731964Medicaid