Provider Demographics
NPI:1578812665
Name:AINSWORTH, RICHARD EUGENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EUGENE
Last Name:AINSWORTH
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 1:2123 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3610
Mailing Address - Country:US
Mailing Address - Phone:318-398-2100
Mailing Address - Fax:
Practice Address - Street 1:2123 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3610
Practice Address - Country:US
Practice Address - Phone:318-398-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist