Provider Demographics
NPI:1780853291
Name:SARTOR, RICHARD D (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:SARTOR
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:PO BOX 1051
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1051
Mailing Address - Country:US
Mailing Address - Phone:573-636-4022
Mailing Address - Fax:573-635-7687
Practice Address - Street 1:226 E HIGH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3207
Practice Address - Country:US
Practice Address - Phone:573-636-4022
Practice Address - Fax:573-635-7687
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0709430001Medicare NSC