Provider Demographics
NPI:1689310542
Name:DUDLEY, RICHARD WARREN III (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WARREN
Last Name:DUDLEY
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7127 TIMBER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-5512
Mailing Address - Country:US
Mailing Address - Phone:419-297-0680
Mailing Address - Fax:
Practice Address - Street 1:4502 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2335
Practice Address - Country:US
Practice Address - Phone:419-476-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03323978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist