Provider Demographics
NPI:1578994604
Name:RICHARDSON, EVAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:RICHARDSON
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 1:8322 VIA SONOMA UNIT 73
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2807
Mailing Address - Country:US
Mailing Address - Phone:805-231-9406
Mailing Address - Fax:
Practice Address - Street 1:8322 VIA SONOMA UNIT 73
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-2807
Practice Address - Country:US
Practice Address - Phone:805-231-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist