Provider Demographics
NPI:1750304531
Name:KANTOR, RICHARD DAVID (RP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DAVID
Last Name:KANTOR
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6863 TIDAL CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-1726
Mailing Address - Country:US
Mailing Address - Phone:760-568-3819
Mailing Address - Fax:815-642-8566
Practice Address - Street 1:6863 TIDAL CREEK AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-1726
Practice Address - Country:US
Practice Address - Phone:760-568-3819
Practice Address - Fax:815-642-8566
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16153183500000X
CA28428183500000X, 183500000X
NE8323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist