Provider Demographics
NPI:1639299001
Name:STAMM, RICHARD D (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:STAMM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53911 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-1930
Mailing Address - Country:US
Mailing Address - Phone:586-781-8631
Mailing Address - Fax:
Practice Address - Street 1:13635 23 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-2906
Practice Address - Country:US
Practice Address - Phone:586-566-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist