Provider Demographics
NPI:1780673624
Name:EZELL, RICHARD STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:STEPHEN
Last Name:EZELL
Suffix:
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 1:6951 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2447
Mailing Address - Country:US
Mailing Address - Phone:423-899-7708
Mailing Address - Fax:423-855-3053
Practice Address - Street 1:6951 LEE HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2447
Practice Address - Country:US
Practice Address - Phone:423-899-7708
Practice Address - Fax:423-855-3053
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist