Provider Demographics
NPI:1609522374
Name:GARRETT, RICHARD DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:GARRETT
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 1:5116 CITATION DR
Mailing Address - Street 2:
Mailing Address - City:WIND POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53402-2375
Mailing Address - Country:US
Mailing Address - Phone:262-672-7859
Mailing Address - Fax:
Practice Address - Street 1:2820 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4950
Practice Address - Country:US
Practice Address - Phone:262-554-1116
Practice Address - Fax:262-554-1162
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19993-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI19993-40OtherWI STATE