Provider Demographics
NPI:1790399384
Name:RICHARDSON, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 TOURA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4511
Mailing Address - Country:US
Mailing Address - Phone:724-797-0897
Mailing Address - Fax:
Practice Address - Street 1:6375 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:LIBRARY
Practice Address - State:PA
Practice Address - Zip Code:15129-8502
Practice Address - Country:US
Practice Address - Phone:412-831-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist