Provider Demographics
NPI:1629666441
Name:RICHMOND, DONALD MART STEWART
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MART STEWART
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COUNTY ROAD 6 W
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-5557
Mailing Address - Country:US
Mailing Address - Phone:574-266-9389
Mailing Address - Fax:
Practice Address - Street 1:175 COUNTY ROAD 6 W
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-5557
Practice Address - Country:US
Practice Address - Phone:574-266-9389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016705A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist