Provider Demographics
NPI:1720398670
Name:MAHIEU, RICHARD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:MAHIEU
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 1:62 E MILL RD STE B1
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3118
Mailing Address - Country:US
Mailing Address - Phone:844-572-7478
Mailing Address - Fax:888-887-1815
Practice Address - Street 1:62 E MILL RD STE B1
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-3118
Practice Address - Country:US
Practice Address - Phone:844-572-7478
Practice Address - Fax:888-887-1815
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00066843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist