Provider Demographics
NPI:1588015994
Name:HARGRAVES, RICHARD BRADFORD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRADFORD
Last Name:HARGRAVES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7846 AVIATION DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5818
Mailing Address - Country:US
Mailing Address - Phone:618-993-2900
Mailing Address - Fax:618-998-1485
Practice Address - Street 1:7846 AVIATION DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5818
Practice Address - Country:US
Practice Address - Phone:618-993-2900
Practice Address - Fax:618-998-1485
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist