Provider Demographics
NPI:1811548209
Name:PLOTHOW, RICHARD OMER
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:OMER
Last Name:PLOTHOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 E 1190 N # 892E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-1999
Mailing Address - Country:US
Mailing Address - Phone:801-857-7590
Mailing Address - Fax:
Practice Address - Street 1:892 E 1190 N # 892E
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-1999
Practice Address - Country:US
Practice Address - Phone:801-796-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT316961-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist